After Action Report / Improvement Plan

Transcription

1 After Action Report Improvement Plan Seasonal Stamina A Winter Storm Sustainability Tabletop Exercise February 11, 2014 North Dakota Department of Health Consolidated 1 Page

2 ADMINISTRATIVE HANDLING INSTRUCTIONS 1. The title of this document is The "Seasonal Stamina - A Winter Storm Sustainability Tabletop 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: Department of Health: Mary Tello-Pool North Dakota Department of Health (Office) ( ) matellopool@nd.gov Exercise Director: Chris Floyd Disaster Resistant Communities Group LLC (Office) ( ) chrisfloyd@drc-group.com 2 Page

3 CONTENTS 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... 9 Exercise Purpose and Design... 9 Exercise Objectives, Capabilities and Activities... 9 Scenario Summary... 9 SECTION 3: ANALYSIS OF CAPABILITIES SECTION 4: CONCLUSION APPENDIX A: IMPROVEMENT PLAN APPENDIX B: PARTICIPANT FEEDBACK (Strengths Areas for Improvement) APPENDIX C: ACRONYMS Page

4 EXECUTIVE SUMMARY Seasonal Stamina - A Winter Storm Sustainability Tabletop Exercise was designed and facilitated provide an opportunity for hospital / long-term care facility staff and management to assess capabilities associated with maintaining operations during a severe winter storm. 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 4 Page

5 Exercise Details SECTION 1: EXERCISE OVERVIEW Exercise Name: Type of Exercise: Seasonal Stamina - A Winter Storm Sustainability Tabletop Exercise Tabletop Exercise Start Date: February 11, 2014 Duration: Sponsor: Three Hours North Dakota Department of Health Program: To provide a learning environment as well as an opportunity to assess current plans and procedures. Purpose: To provide an opportunity for hospital / long-term care facility staff and management to assess capabilities associated with maintaining operations during a severe winter storm. Mission: To provide hospital staff with the opportunity to gain a more comprehensive understanding of the activities associated with maintain operations during a severe winter storm. Scenario Type: Severe Winter Storm Participant Information Participant Location Altru Health System Ashley Medical Center Carrington Health Center Cavalier County Memorial Hospital Community Medical Center Cooperstown Medical Center Edgewood Vista in Minot Elim Care of Fargo 5 Page

6 Essentia Health Eventide at Hi-Acres Manor Fargo VA Medical Center First Care Health Center Good Samaritan Center - Devil's Lake Good Samaritan Society - Fargo Good Samaritan Society - Larimore Hatton Prairie Village Hawks Point Hill Top Home of Comfort Jamestown Regional Medical Center Knife River Care Center Linton Hospital Lisbon Area Health Services Luther Memorial Home Lutheran Home of the Good Shepherd Maple Manor Care Center Maryhill Manor McKenzie County Healthcare System Mercy Hospital Mercy Hospital - Devils Lake Mercy Medical Center Mountrail County Medical Center Nelson County Health System North Dakota Department of Health North Dakota State Hospital 6 Page

7 Northwood Deaconess Health Center Oakes Community Hospital Parkside Lutheran Home Parkwood Senior Living Center Pembina County Memorial Hospital Physicians Hospital Prairie St John's Presentation Medical Center Quentin Burdick Memorial Health Care Richard P Stadter Psychiatric Center Sakakawea Medical Center Sanford Health - Bismarck Sanford Health - Fargo Sanford Health - Hillsboro Sanford Health - Mayville Sanford Hillsboro Care Center Southwest Healthcare Services St Alexius Medical Center St Aloisius Medical Center St Andrew's Health Center St Joseph's Hospital St Luke's Hospital Standing Rock Hospital Tioga Medical Center Touchmark on West Century Towner County Medical Center 7 Page

8 Trinity Health Trinity Kenmare Community Hospital Turtle Lake Hospital Unity Medical Center Vibra Hospital - Central Dakotas Vibra Hospital - Fargo West River Regional Medical Center Wishek Community Hospital Number of Participants Page

9 SECTION 2: EXERCISE DESIGN SUMMARY Exercise Purpose and Design To provide an opportunity for hospital / long-term care facility staff and management to assess capabilities associated with maintaining operations during a severe winter storm. 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: Incident Command / Management System Activity Target Capability # 1 Implement Incident Command / Management # 2 Communications # 3 Resource Management # 4 Develop Incident Action Plan (IAP) # 5 Demobilize Operations Scenario Summary Both the Bismarck and Grand Forks Office of the National Weather Service have just issued a Winter Storm Watch for all of North Dakota. A severe winter storm is predicted to move through the state within the next 12 to 36 hours. As residents throughout the state begin to brace themselves for what is predicted to be a record setting sleet, freezing rain and snowfall the National Weather Service issues a Winter Storm Warning. 9 Page

10 SECTION 3: ANALYSIS OF CAPABILITIES Incident Command / Management System Performance Target Capability Activity # 1: Implement Incident Command / Management Associated Critical Tasks Task # 1.1: Staff establishes Incident Command / Management Pembina County Memorial Hospital Though we do not specifically fulfill all areas of Incident Command positions-staff work quite well together and accomplished all tasks completed. Actually assign specific positions to have duties performed by this staff member to assure all jobs get done. Fargo VA Health Care System Examine positions. Needs Improvement Linton Hospital Not Applicable Getting more people involved in the exercise. Sanford - Hillsboro Medical Center Incident Command structure was not needed. Edgewood Vista in Minot Staff worked as a team and came up with some new ideas. Detailed information needed in disaster policy book. Team will meet to discuss how to add in items needed. 10 Page

11 Strong Parkside Lutheran Home They knew who the Incident Commander will be and what other Incident Command staff roles they need covered. Practice. Maryhill Manor Though the process is not formalized, the management team functions well in an emergency situation and was able to prioritize needs throughout the exercise. It may be good for this team to formalize some of their processes, such as developing a disaster supply needs checklist and a social media policy for staff. Essentia Health Participation by ALL members of Incident Command was lacking. It would have been nice to see the room set up like an Incident Command Center. With so few members participating, there was a lot of guessing as to how a response would be handled by an Incident Command section not present. Maple Manor Care Center Cavalier County Memorial Hospital Luther Memorial Home Strong Trinity Health 11 Page

12 Needs Improvement Binders are in place for each role in the Incident Command plan, which contains a copy of the emergency response plan. Individuals are identified by name on the flow sheets showing who is performing which role. The group quickly determined the incident type and scope; initial actions that need be taken; identified the need for specialized resources and the nature and quantity of additional resources required. Individuals in the room were asked what types of things came to mind when they hear bad weather is approaching. Each individual provided an understanding of the Incident Command plan and how that plan is initiated. A recommendation was made to provide additional training or triggers for the house supervisors on how the Incident Command transitions from a single unit to the entire organization. Hill Top Home of Comfort Only one participant (Safety Director) has any training in Incident Command. A brief introduction to Incident Command was given to all participants. All participants would benefit from additional exposure to Incident Command. Since establishing the Incident Command Center falls primarily on the Administrator, recommendations would be for attendance at Incident Command training sponsored by the SWDH. The Safety Director could also use a review and / or additional training. North Dakota Department of Health Members were given specific roles to play in this event. Strong It would be a good idea to have a plan for managing Incident Command in place at the hospital. Mercy Hospital All participants understand the Incident Command / Management System. Position descriptions were well understood by participants. 12 Page

13 Have a well-planned EOP. Had good representation from all departments of the hospital at this exercise. Nelson County Health System Quick to assign tasks to people. Sanford Health - Bismarck New Administrative Associates need more experience. Strong More training for Administrative Associates. St Aloisius Medical Center Incident Command was established (HICS). Touchmark on West Century Good beginning understanding of Incident Command. Familiar with process and had chart available to assist them in determining what positions needed at specific time. I was impressed with their interest and commitment to the process. Strong Training and exercising. Quentin Burdick Hospital The incident Command System was established immediately with representatives from all key functional areas. Strong Presentation Medical Center The group appeared prepared. They knew first steps as well as where to find answers to issues that arose. 13 Page

14 Carrington Health Center Incident Command established on Saturday. They did test generators. They did call in staff. Supplies are increased during winter months already. They need to pay special attention to setting up Incident Command based on local weather reports earlier. St Andrew's Health Center We are a small facility and Incident Command involves few people that wear many hats Non-Existent Mercy Hospital - Devils Lake Incident Command not established. Participants felt this is common occurrence and is managed by department managers on a regular basis. Develop a plan for management of severe winter weather events. West River Regional Medical Center Incident Command was established immediately upon receipt of Hazardous Weather Notification when it seemed eminent that the normal operations of the hospital would be affected. The hospital's Chief Nursing Officer is identified as the Incident Commander. Southwest Healthcare Services Facility still working on updating HICS. Strong Complete the HICS system then implement. Cross train members to fill different roles. Jamestown Regional Medical Center Staff knew which room would be used for the hospital EOC. Initial Incident Command would be handled by the house supervisor until the on-call administrative staff person could be 14 Page

15 contacted. Staff knew where the cart with the job action sheets / staff position binders was located without prompting from the hospital emergency preparedness staff. Defined the steps that would be taken once a watch / warning was issued including utilizing internal communication systems to keep staff up to date on the changing conditions, making sure cots for staff are ready to go, developing a patient discharge plan, and notifying key individuals via phone / pager. Strong Prairie St John's All Incident Command positions and Section Chiefs were named. Branches were established for each section as well. Altru Health System Group made assumptions based on knowledge of the type of situation (prolonged blizzard) vs talking through the actual scenario at the pace the injects were provided resulting in a larger command structure than may have been appropriate for the stage of the exercise. Stop and assess before taking action. Would be helpful if the hospital s emergency response plan had more specific criteria for when to implement the incident command structure. Mercy Medical Center The individuals present at the exercise, knew who would full fill those roles. Strong It would have been nice to have all Incident Command positions present for the exercise. Sanford Health - Fargo Medical Center Staff members are willing to establish Incident Command. Incident Command training is needed for new leadership within the health system. 15 Page

16 First Care Health Center Would implement as the need arises depending on scale of event. Staff well aware of Incident Command System and its protocol. Confer with Administration, Director of Nursing and Safety / Security which they did identify. Good Samaritan Society - Larimore Good discussion and brainstorming. Northwood Deaconess Health Center Command structure for facility is listed in current operations manuals, to include backups for individuals that are unavailable. Task # 1.2: Initiate and implement Incident Command / Management. Needs Improvement Pembina County Memorial Hospital As above not each job is specifically assigned, but tasks did get done. Assign positions. Fargo VA Health Care System Linton Hospital Not Applicable Sanford - Hillsboro Medical Center 16 Page

17 Edgewood Vista in Minot All members aware of Command Center and knew who to ask when they had questions. Strong Items needed in writing in case some members are not present Parkside Lutheran Home They knew at what times they would need to initiate Incident Command. Participate in drills / exercises to practice these roles. Maryhill Manor Essentia Health The Incident Command System was established early on in the exercise. Maple Manor Care Center Cavalier County Memorial Hospital Needs Improvement Luther Memorial Home Strong Trinity Health 17 Page

18 Identified individuals by name on our flow sheets and assigned the roles to the individuals in the room. Individuals in the room were asked what types of things came to mind when they hear bad weather is approaching. Each individual provided an understanding of the Incident Command plan and how that plan is initiated. Needs Improvement Hill Top Home of Comfort After the brief review of Incident Command, uncertainty remained about who would fill positions of the Incident Command tree. Each Department Head discussed their role in the management of an incident. With improved education, administration will be able to determine levels of the Incident Management tree and the change in responsibilities of the supervisors under him in an emergency situation. North Dakota Department of Health There was a little confusion as to when to start viewing the scenario as an emergency situation. Detailed measures of when to put to action plans in place are advised. Mercy Hospital Due to commonality of severe weather in North Dakota, it was difficult for participants to see that this storm may require implementation of ICS. Develop triggers that would key staff into implementing ICS. Consider PIO as a separate position from the hospital CEO. Hospital CEO can continue to be the spokesperson but may need assistance in preparing press releases and other information for the media / public. At what point would administration that is not working, be contacted? Nelson County Health System 18 Page

19 Hard to fill roles with such a small staff. More practice with these skills. Sanford Health - Bismarck More training. St Aloisius Medical Center Department heads were knowledgeable of their role. Ensure designees are identified and know their role also. Touchmark on West Century Initiated and implemented appropriate levels at appropriate times. Once again, training and exercising Quentin Burdick Hospital The IC also acted as the PIO. I recommend that another individual (with experience) act as PIO since the IC will be too busy with disaster response planning. Still, there will be occasions where direct quotes from the IC are necessary. Having pre-planned scripts for all-hazards planning might be a means to facilitate getting messages out to the public. Presentation Medical Center The group identified the need to update the contents of the Disaster Box. Carrington Health Center Good implementation. Appropriate staff was called in however Incident Commander needed to fill Finance Section responsibilities also. Have all staff positions filled. 19 Page

20 Strong St Andrew s Health Center We use IC at some level regularly here for different situations. Non-Existent Mercy Hospital - Devils Lake Discussed when administration should be called in. Many department managers are long-term and have experience to manager. Identified house coordinator as Incident Commander. Participants were managers of various departments and easily described action plans for mitigation. Develop EOP to include severe winter weather. West River Regional Medical Center Staff had good awareness of the Incident Command System (ICS) Command and General Staff positions were discussed, identified, and staffed as needed from within the hospital administration. The Incident Commander would also be the Operations Section Chief, the Chief Clinical Officer would serve as Logistics / Planning Section Chief, the hospital's CEO is the Public Information Officer (PIO), and the Chief Financial Officer would be the Finance / Administration Chief. Persons were identified to be recipients of the information from the NWS (National Weather Service). The hospital has people in-house that are responsible for Communications and Safety on a daily basis. Needs Improvement Southwest Healthcare Services Most of the staff members were unsure of the HICS system. Strong Managers need to be trained in the HICS system and the lead when the need arises. Jamestown Regional Medical Center Hospital staff set up ICS early on in the exercise and identified who would be in command and filled the command staff positions. 20 Page

21 Staff developed a solid IAP for the first twelve to fifteen hours of the incident that identified the steps that would need to be taken to prepare the hospital for this event. The IAP included such items as calling in out of town staff back to stay at the hospital, identifying critical staff, cancelling elective procedures / contacting patients, and keeping employees apprised of the situation using the internal communication channels and many other steps that must be taken care of to make sure the facility was ready. There was a good discussion about whether virtual ICS would be beneficial to the organization. The consensus of the staff sitting around the table is that ICS is better done in person versus virtually. Their view is face to face communication is better for both staff and by extension the patients. Strong There appears to be a need to better define second shift (overnight) Incident Command staff earlier in the process. It may be helpful to determine whether the full IC structure needs to be staffed at night since some positions such as finance may not be needed over nights. Prairie St John s Strong Altru Health System Quick to gather into appropriate roles. Once in roles the communication became very informal vs following a more formal process where each individual played their specific part. Mercy Medical Center Again, input from those individuals would have been nice, but were absent. Sanford Health - Fargo Medical Center Checklists are in place to help determine if Incident Command should be implemented. 21 Page

22 Training needs to be conducted in regard to what triggers activation of Incident Command and to build confidence in those tasked to make the decision. First Care Health Center Good Samaritan Society - Larimore Need to work on some things but did not assign follow-up tasks Northwood Deaconess Health Center Operations manuals are in place for direction of staff. More specific timelines may be beneficial to implementation of emergency operations. Performance Target Capability Activity # 2: Communications Associated Critical Tasks Task # 2.1: A system of communicating timely and accurate information was established and maintained. Pembina County Memorial Hospital Staff are able to communicate among themselves to adequately get work done. Fargo VA Health Care System Develop a communications plan. Linton Hospital 22 Page

23 Strong Sanford - Hillsboro Medical Center Edgewood Vista in Minot Have established a protocol for how everyone is notified and who is responsible for each area. Strong Details needed in disaster book. Parkside Lutheran Home They have a good structure set up of communicating with staff / residents families and what information could be given out. Practice Maryhill Manor Essentia Health Thorough consideration of all alternate communication methods was discussed. Perhaps test the alternate communication methods at some point during the year. Again lack of participation was unfortunate. Maple Manor Care Center Cavalier County Memorial Hospital 23 Page

24 Luther Memorial Home Strong Trinity Health We utilize cell phones, radios and runners to communicate. Radios are color coded by role operations, such as operations (red), planning (yellow), logistics (blue) and finance (green). The group showed an understanding of how the communication tree should function and why the radios were set to certain access codes. Each section communicates needs to their section chief who in turn contacts the appropriate section chief to obtain those resources. The switchboard has weather radios (NOAA) and a CityWatch system is used to notify chiefs and senior leaders. A public information officer is in place to communicate to the public and families. Needs Improvement Needs Hill Top Home of Comfort alerts and updates for families were discussed, but at this time we do not have many of the addressed for the residents contact persons. We do have the ND Health Alert System for staff available for use to send notices out to all employees. This list is current and continues to be updated. We have established that Administration will communicate with outside entities such as the media. The SSD will assist with contacting and updating resident families. We could make more of an effort to get addresses from the resident's family members. There is a need for more testing of the ND HAN system (drills) to ensure that staff are aware of the system and accept the notices. North Dakota Department of Health 24 Page

25 Improvement Confusion on how serious the event was at that time or who should be contacted. Determine measures and procedures. Mercy Hospital Current EOP / inclement weather policy does not include a communication plan. They have had to utilize the EOP, etc. during spring flooding, evacuation planning, etc. so have a good handle on communicating with staff, not all in policy format. House supervisor may need to delegate some responsibilities as it feels like much of the EOP falls on that position? Add communication plan to inclement weather policy. Nelson County Health System Good communication and listening skills, open to suggestions. Strong Sanford Health - Bismarck Strong St Aloisius Medical Center Currently the hospital switchboard is relied on too much. This could be a problem with turnover and lack of training. Define established communications systems. System #1 will be used, if that is not available; System #2 is used, etc. Be sure staff knows and has access to the Communication Systems. Ongoing training will help. Touchmark on West Century Always concerned about internal and external communications. Included family as well. Strong here. Sign up for reverse call back HAN for staff and families. 25 Page

26 Quentin Burdick Hospital Needs Improvement Generally, Incident Command communications were both timely and appropriate. However, use of the hospital's reverse phone call notification was not initially used. The IC recognized this over-sight a couple of "days" into the exercise and called for its use. When the call was made to the Tribal Emergency manager, all exercise participant were surprised to learn that no tribal support was available. Rather, the IC was referred to the state for emergency support. While some hospital staff, including the CEO, receive weather updates from the National Weather Service (NOAA) via text or , there aren't any weather radios within the hospital I recommend use of the hospital's capability of reverse phone notifications, as well as other means like the TV and radio public service announcements, as a means to alert all staff of any hazard as appropriate. I recommend that professional relationships be built and / or reestablished with those Tribal, State and Federal agencies in the Turtle Mountain community. Where regulations permit, I recommend that MOU's be written and agreement sought with all partners. Receiving timely weather information is vital to planning. Thus, I recommend the procurement of at least 3 weather radios: 1 for Incident Command, 1 for the ER and 1 for the Facility manager. Presentation Medical Center Communications was particularly challenging in this exercise. There was thorough discussion regarding resources, alternative options, availability and readiness. The group identified some concerns when calling NDDOH to request help for a code WHITE. These will be investigated and the PMC Disaster Plan will be updated accordingly. Carrington Health Center A PIO was included, PIO updates every 4 to 6 hours, set up communication with EOC, Inform staff of magnitude of incident and do regular updates in house. 26 Page

27 Emergency preparedness training for at home staff and family. St Andrew s Health Center Needs Improvement Strong Mercy Hospital - Devils Lake Most participants unaware of who receives weather warnings and how this information is disseminated. Usually house supervisor informs managers. Minimal awareness of community resources, state and how to access. No formal plan. Discussed mode of communication options. Communication plan to be inclusive of hospital resources, community and state resources and how to access. Include public service announcements and scripting templates. West River Regional Medical Center The hospital has very good plans in place for disseminating information to administrative staff and their management team. (Hospital has the ability to use conference calling although it has not been utilized yet.) Discussion was held on how information would be shared and with whom. Different methods of communication were discussed for disseminating information to employees, families of hospital patients, and the general public. Proposed methods were by phone, internet, and radio messages. Also, specific phone numbers would be given and times set for persons to call the hospital for more information, so they would not be inundated with phone calls, as they would possibly be working with limited staff. The PIO would issue statements at specific times to the news media. Area to research - Question: If the hospital's communications antennas are inoperable or destroyed; would they be able to communicate with Law Enforcement or the EOC outside the hospital facility? 27 Page

28 Southwest Healthcare Services The calling tree was initiated and staff members were called into work before the storm hit. Strong Continued updating calling tree. Possible purchase of radio to be able to talk with EOC. Jamestown Regional Medical Center Strong Using the PIO, messaging was implemented utilizing internal systems, - , phone calling trees, social and traditional media in order to keep staff, patients, and the public informed of the status of the hospital. The staff sitting at the table during this exercise knew what messages would need to be communicated about their specific area(s) of responsibility both to the IC and to the PIO for messaging to staff and the public. I was unsure if some of the messages were already created and would be tailored to the event. If messages weren't developed already, the development of pre-canned / preapproved scripts may be useful for common messaging needs such as winter storms. Prairie St John s We have policy's that address communication along with information received. This was established in the Planning Section. Altru Health System Players tended to speak from a department level (day to day role) vs viewing the incident from a total organization viewpoint. Preparation for the exercise should have been clearer so players understood to stick to their assigned roles. Some concern that the same thing might occur in a real event. Certain roles, such as the PIO, were not emphasized enough and could have had that position more integral to some main discussions. Mercy Medical Center The individuals present, knew a great deal on how staff would 28 Page

29 communicate if available and if not available. Strong Strong It would have been nice to have their IT staff available for the exercise, and discuss it more in depth. Sanford Health - Fargo Medical Center PIO has templates and guidelines in place for disbursing relevant information to staff and the public. In the event of power failure, backup information dissemination processes are in place. Need to identify ways to reach staff members who don't check organization's web site or when not at work. Mass text and calling options are available, but not currently utilized for blanket communication. First Care Health Center Pointed out that the staff notification system would be utilized. BTWAN system, state radio, cell phones, etc. Questions would be fielded by PIO and / or appointed individual. Need to develop written policies and procedures for media response. Draft a scripted message for addressing patient's family members concerns etc. Good Samaritan Society - Larimore Needs Improvement Northwood Deaconess Health Center A specific operational checklist would be beneficial to ensure how communication is handled during the event. Performance Target Capability Activity # 3: Resource Management 29 Page

30 Associated Critical Tasks Task # 3.1: Establish processes to order, track, assign and release incident resources. Pembina County Memorial Hospital Staff members are aware of supply cache. Strong If feasible it would be a good idea to have additional resources available for emergent situations. Need a better tracking system. Fargo VA Health Care System Needs Improvement Linton Hospital Sanford - Hillsboro Medical Center Strong Edgewood Vista in Minot Processes in place. Communicate more as a team about each other s knowledge of HANS ASSETS and each other s responsibilities. Parkside Lutheran Home They knew what resources would need to be ordered in preparation of a situation that would require them to essentially shelter in place. Practice with drills / exercises. Maryhill Manor 30 Page

31 Essentia Health Vulnerabilities were identified with each department. Essentia Health's IC team has improved quite a bit during the past year. Processes should be exercised in the near future. Maple Manor Care Center Development of facility guidelines to help in tracking resources could be beneficial. Cavalier County Memorial Hospital Needs Improvement Luther Memorial Home Strong Trinity Health Labor is activated; calling trees are in place, lodging and food arrangements and tracking are in place. We have a plan to set up a temporary day care if need be so staff can be available. Home Health has a separate disaster plan that is in place. The binders contact a recording sheet that can be used to track resources, although most of this done verbally. Hill Top Home of Comfort Our current system may be adequate to manage resources. We have 2 to 3 weeks of non-perishable food and 1 to 2 weeks of nursing supplies available at any time. 31 Page

32 Resident medication may be a concern area depending on at which time in the 2 week medication cycle the incident happens. Plans for minimum staffing requirements for all departments have been developed. Additional diesel may be required to maintain generator function after the short term. We may have housing needs for dependents of staff members during the incident. We do not have mutual aid agreements in place. Work on establishing relationships with entities that may help us, including the Dunn County Emergency Manager, other area nursing facilities, the NDLTCA, and local resources for medications, fuel, food, and possible lodging. Sign mutual aide agreements with local resources. North Dakota Department of Health There seemed to be some understanding of how resources would be managed. A little more preparation from the hospital and less dependency on the staff to provide for their own needs. Mercy Hospital Good discussion regarding generator use and energy needs while utilizing generator. Discussion regarding laundry, drugs, food, water, staff, electronic med record policy. Staff is well educated on current inclement weather policy and will make themselves available as possible. Develop policy regarding provider s responsibility to stay in the hospital until a replacement is able to get there. May want to enhance current policies to include modified cares policy and when to implement, when house supervisor would contact pharmacy regarding adequate drug supply, etc. (at day 2, day 4??). Nelson County Health System Have a good handle on resources but is a problem when there is no travel - will items get to us. Need to know where generators are in town and what will run 32 Page

33 on them. Sanford Health - Bismarck St Aloisius Medical Center Each department is responsible for what they need. Supply needs were assessed often. Identify a resource manager. Forms / training will help with this. Need a plan on releasing resources. Keep in mind that requesting supplies early so you're not scrambling to find supplies last minute. Touchmark on West Century Good conversation about who could take on what role best throughout facility. Needs Improvement Brainstorming and establishing some guidelines. Quentin Burdick Hospital As the evaluator, I gained little sense of how much of any resource was on hand and how long that resource would support sustained hospital operations, especially with staff and possibly family members sheltering in-house. I heard generalizations pertaining to water, food, bedding, fuel, but no quantifiable amounts or how many days supply that would translate to. As an example, one concern is for adequacy for fuel (diesel) to power the hospital's skid steers which are vital to clear snow close in to the hospital. Currently, skid steers are driven to the neighborhood store for tanking off which is located about 0.1 miles away. There are no assurances of the store being opened during a winter storm. I recommend that inventories be made of all hospital resources should there be any disaster (blizzard, flooding, tornado, etc.). Further, an assessment should be made to determine if the quantities are adequate or not. Thus, if the hospital is placed in the situation of sustainment 33 Page

34 then an accurate account of supplies will be available. I recommend that the hospital procure a fuel tank (possibly 500 gallon capacity) to ensure adequate supply of diesel fuel. Presentation Medical Center Needs Improvement Carrington Health Center 2 week supply of fuel for generator, have disaster supply stock, called HR personnel to track,. Strong No one to track supplies. No mention on how to get supplies here till later in scenario. St Andrew s Health Center Again they are a small facility and this was relatively easy for them. Needs Improvement Mercy Hospital - Devils Lake Each participant described what they would need to track. No defined mechanism for tracking resources available. Identified staffing needs, recognize majority of clinical staff live several miles from facility, they make arrangements to come early for assigned shifts and make plans to stay as needed. Develop templates to be used to track resources, include this in plans. West River Regional Medical Center Good discussion was held on what resources could be needed and how and where to obtain them. The hospital's Emergency Operations Plan would be utilized. The local Emergency Services Office, SWDHU (Southwestern District Health Unit), and / or the State Department of Health could provide assistance or resources if needed. The MRC (Medical Reserve Corp) might be requested. Local volunteers may be utilized. 34 Page

35 The hospital has contracts in place for snow removal around their facilities. Requested resources would be directed to report to a staging location, check in and would be under the direction of the Incident Commander. The Planning / Logistics Section Chief would be responsible for procuring/tracking the resources and the Finance / Administration. Officer would be responsible for keeping track of time and costs. Resources would be released as soon as possible when the situation improves under direction of the IC. Strong Concerns expressed were limited fuel for the backup generator and the availability of food resources if on-site supplies are exhausted. More research could be done and plans developed for those needs. Southwest Healthcare Services CS was brought in to take the Logistics portion. Strong Possible better handle on supplies on hand. Jamestown Regional Medical Center The hospital indicated that they would use their internal tracking systems for employee time tracking, purchase orders, etc. to track resources that are used during this incident. The hospital indicates that they do not use the MRC, but it does have policies and procedures in place to credential professional staff that may self-volunteer during a disaster. Strong Prairie St John s Policies are in place for this. These items were addressed in the Operations Section and in the Logistic Sections. Needs Improvement Altru Health System 35 Page

36 Strong During the exercise all communication was a bit ad hoc and chaotic. It was difficult to tell if a stronger facilitation of the exercise would have helped or if the group needs more training on the Incident Command process. In the end, however, the resources were all discussed and identified so the intent of the exercise was accomplished. May have been helpful to have had resources and sustainability list printed for the exercise. Mercy Medical Center Staff at the hospital knew, documentation is key in a disaster. I think they would do well in this area. Strong Sanford Health - Fargo Medical Center A computerized program is in place to process orders, track and assign resources. Identified that no current backup plan is in place if the computer system fails. First Care Health Center Noted access to state cache which would be utilized. Also, local services / businesses would be contacted to acquire items needed food, water, etc. These concerns or possible situations have been addressed in our EPR manual. Needs Improvement Good Samaritan Society - Larimore This is the area that needs the most work. Needs Improvement Do not have enough resources in stock and do not have a system for making sure there are adequate supplies for such an emergency. Northwood Deaconess Health Center 36 Page

37 No one position is currently listed as responsible for tracking resource needs and requirements. Establish position responsible and create check list for operations. Performance Target Capability Activity # 4: Develop Incident Action Plan (IAP) Associated Critical Tasks Task # 4.1: Establish incident objectives, priorities and operational periods. Needs Improvement Pembina County Memorial Hospital Staff members are just trained to very basic level of knowledge of plan. Educate the staff to a higher level staff seems be able to prioritize situation Fargo VA Health Care System Need to work on this. Linton Hospital Sanford - Hillsboro Medical Center Needs Improvement Edgewood Vista in Minot Was not able to complete. Have all members present to write detailed objectives and 37 Page

38 priorities. Strong Parkside Lutheran Home They are aware of what takes priority and what could be cut from operations. Practice Maryhill Manor Essentia Health I was impressed with how they tackled the issues and were able to prioritize efficiently. Concern for patient and staff was always at the forefront of any decision. Because of low participation, several objectives were omitted. Far too little time was spent working through objectives during each operational period. Maple Manor Care Center Development of facility guidelines for preparation of specific action plans would be beneficial. Cavalier County Memorial Hospital Luther Memorial Home Strong Trinity Health The IAP is not usually put in writing yet the components are done verbally. 38 Page

39 We do have contracts and agreements in place to ensure we have resources such as supplies, water, food and transportation. We do communicate with the Ward County Emergency Management Office, fire and police departments through a liaison. Needs Improvement One recommendation for improvement is to approach MSU about utilizing nursing department instructors in an emergency situation to augment our labor pool. Hill Top Home of Comfort Facility has minimal systems in place to guide actions in the event of an incident. Disaster and winter staffing policies need to be expanded on to meet an all hazards approach to handling a disaster. Needs Improvement Train on how to develop an IAP North Dakota Department of Health More confusion and assumptions. There were strengths in some plans like Shelter in Place procedures already established that would manage certain aspects of the operational periods and some objectives. Strong Clearly define goals and plans. Mercy Hospital Everyone offered input to IAP and quickly developed objectives that were agreed upon. Good discussion regarding staff family shelter and able to determine that this would be an issue which would be discussed with the command staff and a plan would be put in place as needed at that time. Quickly developed a plan / solution when the roof of the hospital began leaking in the patient care area. Handled media request professionally and appropriately. Attempted to contact ND Department of Health who would have good resources. Empathetic but realistic as far as staff fatigue concerns. Radio tower located at the armory, unsure if there is generator 39 Page

40 backup there. Contact emergency manager early in the incident; as a courtesy or a head's up (even if you do not need resources) would be good to idea when the EOP is activated. Likely, the NDDOH would have been notified early in the situation also, may want to add this to the EOP? Nelson County Health System Quick to make sure our patients were taken care of first, and very compassionate and understanding for staff and family members. May be unrealistic to be able to take care of our patients, their families, staff, their families and the community. Sanford Health - Bismarck St Aloisius Medical Center Good understanding that staff / resources need to be "refreshed". Strong This will improve with training / forms on how to begin planning for the next "operational period". Touchmark on West Century Only selected a few for time sake, however, picked the most important and objectives were SMART. Good working knowledge. Practice. Quentin Burdick Hospital The IC, with the support of other staff, quickly developed action plans. The Operations Team was tasked with quickly (but safely) moving patients and staff into safe areas of the hospital. The Maintenance Team was tasked with clearing the snow off the roof and assessing the "broken" roof damages. The Communications Team lines were quickly set up for families to be updated on patients status. 40 Page

41 Presentation Medical Center Carrington Health Center Written action plan was developed. List of objectives that fit this scenario was completed and updated as necessary. More communications with outside sources for help. St Andrew s Health Center Unsure Mercy Hospital - Devils Lake Easily identified priorities and plan of action. Not done in formal manner. Develop templates for this. West River Regional Medical Center Incident objectives were quickly set and prioritized: Ensure safe travel for employees, snow removal for emergency resources, adequate staff for hospital departments, acquire / provide accommodations / food for staff, conserve resources. Plans are in place to meet these objectives through utilization of the hospital's All Hazard's Manual and obtainment of these objectives would be "as needed". Some objectives could be met prior to an incident with advance warning. Some actions discussed for operation during a disaster or emergency situation include cancelling elective procedures, potential clinic closures, changing of shifts for different departments, and utilization of clinic nurses for hospital shifts. Sheltering employees' families was discussed but did not seem feasible as hospital resources would already be stressed. 41 Page

42 Needs Improvement Southwest Healthcare Services Nobody has ever established an IAP. Strong Managers need training on IAP's. Jamestown Regional Medical Center Strong Staff developed an IAP that addressed what would need to be accomplished during the initial hours and / or days of event. During the process of developing the IAP, staff did indicated when each task should be accomplished by. Staff did not indicate how long shifts would be for command and operational staff. It was assumed to be 12 hours, but later in the exercise, it was indicated that the initial command staff personnel would be working for hours straight before they would be relieved. Define more concrete operational periods so staff can be relieved from duty for rest / relaxation to prevent burnout over the duration of a multiple day event. Considering that during certain events staff may end up staying hospital during their off time, it may be beneficial to implement a policy that off-duty personnel remain outside the operations / command area in order to facilitate resting and relaxation. Prairie St John s We have an IAP for a blizzard of this magnitude. Needs Improvement Altru Health System Group was confident on overall objectives and actions to be taken but was not strong enough in setting exact achievable goals and planning for command debrief or hand off for operational periods. Strong Group needs additional training on setting SMART objectives. Required strong facilitator input to establish appropriate objectives and even then the objectives were a bit vague. Mercy Medical Center The staff discussed priority areas of the hospital that would 42 Page

43 have to stay open and areas where they would reschedule (Selective surgeries, physical therapy and Craven Hagen Clinic). Sanford Health - Fargo Medical Center Leadership in each command section is confident in establishing objectives and priorities. Processes have been pre-established to address many scenarios. Procedures for changing operational periods need to be reviewed and enhanced. First Care Health Center Incident objectives were identified during the exercise. Caring for patients, caring for staff and maintaining staff numbers. Staff members have the drive and committed strengths and mentality to aid and meet the need. Cross training and staff ability and assist in areas that they are qualified and / or comfortable is and has been our experience. Good Samaritan Society - Larimore Northwood Deaconess Health Center All command staff is fully aware of all that needed to be accomplished. Performance Target Capability Activity # 5: Demobilize Operations Associated Critical Tasks 43 Page

44 Task # 5.1: Evaluate conditions to determine actions to be taken to demobilize operations. Needs Improvement Pembina County Memorial Hospital Staff members have not had to perform these duties very often, but seem to regroup and get tasks done. Train staff to be more adept with these tasks could use a better system to 'wrap up' the situation so staff has closure. Fargo VA Health Care System Linton Hospital Sanford - Hillsboro Medical Center Needs Improvement Edgewood Vista in Minot Team liked the forms given as examples to be used. Strong Put policy in place and come up with forms for remobilization. Parkside Lutheran Home Because it is a long-term care facility not much would change because residents live there day to day. Practice. Maryhill Manor 44 Page

45 Essentia Health While this would be ongoing processes, I think issues were identified quite well. Maple Manor Care Center Cavalier County Memorial Hospital Luther Memorial Home Strong Trinity Health We have business interruption insurance and we document resources used. We prioritize actions to determine which operations should be re-opened first (such as clinics); prioritize patient discharges and determine how staff that remained across shifts will be compensated. Needs Improvement Hill Top Home of Comfort No system in place. Plans to demobilize should also be developed. North Dakota Department of Health There was a good understanding of when to release assets and resume normal operations. 45 Page