After Action Report / Improvement Plan

Transcription

1 After Action Report Improvement Plan Tennessee Twister A Tornado Response Tabletop Exercise May 20, 2015 Upper Cumberland Healthcare Coalition Consolidated 1 Page

2 ADMINISTRATIVE HANDLING INSTRUCTIONS 1. The title of this document is The "Tennessee Twister - A Tornado Response 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: Healthcare Coalition Contact: Kristi Langford Upper Cumberland Healthcare Coalition (Office) ( ) kristi.langford@tn.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... 7 Exercise Purpose and Design... 7 Exercise Objectives, Capabilities and Activities... 7 Scenario Summary... 7 SECTION 3: ANALYSIS OF CAPABILITIES... 8 SECTION 4: CONCLUSION APPENDIX A: IMPROVEMENT PLAN APPENDIX B: PARTICIPANT FEEDBACK (Strengths Areas for Improvement) APPENDIX C: ACRONYMS Page

4 EXECUTIVE SUMMARY Tennessee Twister - A Tornado Response Tabletop Exercise was designed and facilitated as an opportunity for the healthcare coalition's members to work through scenario information and injects dealing a series of tornadoes striking the area. During the exercise participants assessed their individual organization's protective action capabilities and initial response and coordination actions. 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: Tennessee Twister - A Tornado Response Tabletop Exercise Tabletop Exercise Start Date: May 20, 2015 Duration: Location: Sponsor: Three Hours Tennessee Upper Cumberland Healthcare Coalition Purpose: The purpose of the exercise was to provide an opportunity for the healthcare coalition's members to work through scenario information and injects dealing a series of tornadoes striking the area. During the exercise participants assessed their individual organization's protective action capabilities and initial response and coordination actions. Scenario Type: Tornado Participant Information Participant Agency / Organizations Cedar Hills Senior Living Celina Health and Rehabilitation Center Cookeville Regional Medical Center Cumberland Medical Center Cumberland River Hospital DeKalb Community Hospital Heritage Point Senior Living Highlands Medical Center Jamestown Regional Medical Center Livingston Regional Hospital 5 Page

6 Macon County General Hospital Morningside Assisted Living of Cookeville NHC - Cookeville Overton County Nursing Home Plateau Mental Health Center Regional Medical Communications Center River Park Hospital Riverview Regional Medical Center Stones River Hospital Ten Broeck Tennessee Number of Participants Page

7 SECTION 2: EXERCISE DESIGN SUMMARY Exercise Purpose and Design The purpose of the exercise was to provide an opportunity for the healthcare coalition's members to work through scenario information and injects dealing a series of tornadoes striking the area. During the exercise participants assessed their individual organization's protective action capabilities and initial response and coordination actions. 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: Hospital Medical Surge Activity Target Capability # 1 Incident Management # 2 Increase Bed Surge Capacity # 3 Medical Surge Staffing Procedure Long-Term Care Facility Incident Command / Management System Activity Target Capability # 1 Implement Incident Command / Management # 2 Communications # 3 Develop Incident Action Plan (IAP) # 4 Demobilize Operations Scenario Summary 7 Page

8 Saturday 4:23PM As the Chief Meteorologist at the local forecast office of the National Weather Service monitors the regional radar he notices that the storm system that has been approaching from the west is moving into the area more rapidly and intensely than previously forecast. The National Weather Service now predicts that a line of severe thunderstorms with gusty winds and hail along with a potential for tornadoes is expected to move through the forecast area between 6:00PM and 8:30PM. Based on this prediction the National Weather Service issues a Tornado Watch for the region. Issued 4:23PM Tornado Watch Expires 9:30PM Weather Radios throughout the area sound their alarm due to the Tornado Watch being issued. Saturday 6:02PM Meteorologists at the local forecast office of the National Weather Service identify a thunderstorm on their Doppler weather radar capable of producing a tornado. They immediately issue a Tornado Warning. The tornado is tracking from the southwest and is expected to move through the heart of the community. 8 Page

9 SECTION 3: ANALYSIS OF CAPABILITIES Hospital Medical Surge Performance Target Capability Activity # 1: Incident Management Associated Critical Tasks Task # 1.1: Activate the health care organization s Emergency Operations Plan (EOP). Highlands Medical Center DeKalb Community Hospital Cumberland Medical Center Regional Medical Communications Center Facility had a clear plan of when to activate the hospital s EOP. Jamestown Regional Medical Center Identified the need to educate more people on the automated phone system to alert staff of disaster and need to report. Actions have already been made to educate more staff on the activation of system Cumberland River Hospital 9 Page

10 The plan is in place and easily accessible. Needs Improvement All support staff should be trained on the use of the SMART tag system and triage log. River Park Hospital Staff was not sure of policy and procedures and individual responsibilities. Communication good with Warren County EMS and EMA. supply of resources and assets. Re-education of staff and education of new directors of policy, procedures and HICS. Livingston Regional Hospital Riverview Regional Medical Center The team did an excellent job at immediately activating the emergency response team and assigning roles and responsibilities. The Incident Commander immediately took action by giving out the roles and responsibilities, along with the manual. Their HICS vests were on. Messages were sent out to staff via phone, by text and audio. There was a full explanation of all current patients and possible disposition. Elective surgeries were put on hold. The text that was sent out was not complete. Determine a person to activate the Disaster Code during off hours if management is unable to be reached via phone. Determine who to transport both the portable hospital at Cookeville and then who to transport the portable morgue, and what happens if the roads are blocked. Cookeville Regional Medical Center Team came together very quickly and each knew their tasks well 10 Page

11 Need a clear exchange of authority; when house supervisor becomes Incident Commander, there should be a clear exchange of authority with the person assuming the house supervisor role. This held true for each Incident Command staff role. Each position both within ICS and floor staff should have primary and secondary roles pre-defined to lessen confusion during incident. Macon County General Hospital Task # 1.2: Conduct incident action planning. Highlands Medical Center DeKalb Community Hospital Cumberland Medical Center Usual procedures were followed. Emergency Department and inpatient status assessed and prepared. Regional Medical Communications Center Jamestown Regional Medical Center 11 Page

12 Cumberland River Hospital The demobilization plan is not clearly defined. Add clearly defined steps and / or actions to the demobilization plan to make it easier to follow. River Park Hospital Once the Incident Command was established she was able to guide the group in the correct direction. Support was in place but some were not aware of them. Re-education of staff and education of new directors of policy and procedures and HICS. Livingston Regional Hospital Riverview Regional Medical Center The Incident Commander kept everyone on track. The team called lab to determine the amount of blood on hand. Emergency Department nurses determined staffing and equipment needs. The team notified physicians and the specialty clinic for assistance. Materials Management was able to call in staff. The Incident Command Center called Trousdale and Sumner for additional needs. The Incident Command Center began to update HRTZ and have EMA set up. Cookeville Regional Medical Center Role definitions well played. Cleared Emergency Department to secondary location to prepare for incoming injured patients. This incident in itself would not have overwhelmed the facility as they were very organized and acceptance well thought out. There was not a lot of discussion concerning the self-transport and victim families overwhelming the Emergency Department. 12 Page

13 Would suggest looking at plans with law enforcement to preplan this type of incident where sheriff department or surrounding city / county police respond to hospital for traffic and crowd control. Without this happening automatically, the hospital could quickly lose control by the volumes of walking wounded and families of victims. Macon County General Hospital Performance Target Capability Activity # 2: Increase Bed Surge Capacity Associated Critical Tasks Task # 2.1: Implement bed surge capacity plans, procedures and protocols. Highlands Medical Center DeKalb Community Hospital Cumberland Medical Center Plan was recently practiced in response to an actual event (ice storm) and participants agreed this had prepared them for the exercise. Regional Medical Communications Center Facility was quick to cancel elective procedures and quick to identify alternate care areas such as same day surgery and overflow floors. 13 Page

14 Jamestown Regional Medical Center Identified the need to change some of our processes in order to reduce possible congestion in certain areas. Will change some of our staging areas to reduce possible congestion and increase throughput of patients. Cumberland River Hospital Patient overflow areas are designated in the plan. River Park Hospital ED Director was prepared to send patients from ED to M/S who was able to take patients. Clinical leads very well versed in the surge capacity.. Livingston Regional Hospital Riverview Regional Medical Center The team initially ran through patients (inpatients and outpatients) to determine disposition and who would be able to be discharged. They called the nursing homes and physicians to help make dispositions ASAP. Used the ED lobby for the walking-wounded. The Command Center determined locations for the influx of patients to be transferred in. Question came up: Can the hospital use rented space? Determine or review - designated areas for media, families, child care, safety and security. Cookeville Regional Medical Center Well thought out and executed well. 14 Page

15 Macon County General Hospital Task # 2.2: Maximize utilization of available beds. Highlands Medical Center DeKalb Community Hospital Cumberland Medical Center Regional Medical Communications Center Jamestown Regional Medical Center Felt we have a good process in place to utilize beds and space we have available. Cumberland River Hospital River Park Hospital 15 Page

16 Clinical leads very well versed in surge capacity. Knew what patients could be discharged, etc. Livingston Regional Hospital Riverview Regional Medical Center The team was highly aware of current patient volume to determine needs to maximize utilization of beds. Excellent job! Large white board in the Command Center to write down the plan so everyone in the Command Center can see the plan (# of patients arriving, etc.). Determine a process for missing people (pictures with disposition) and add to the policy. Cookeville Regional Medical Center Bed counts and internal communication went well. Macon County General Hospital Hospital leaders identified that when discussing diversion that the Diversion Policy was not a part of the Emergency Operations Plan. Remove the Diversion Policy / Procedures from the Administrative Manual and include it the Emergency Operations Plan. Performance Target Capability Activity # 3: Medical Surge Staffing Procedure Associated Critical Tasks Task # 3.1: Recall clinical personnel in support of surge capacity requirements. Highlands Medical Center 16 Page

17 DeKalb Community Hospital Cumberland Medical Center Regional Medical Communications Center Facility has mass notification systems in place to notify staff in an emergency. More planning on alternate methods of contacting staff when phones / internet is down Jamestown Regional Medical Center Identified need to improve our process of activation of automated call system that notifies staff of disaster and need to assist Cumberland River Hospital A list of personnel phone numbers and cell phone numbers is available and easy to access. River Park Hospital Most directors were contacting people on the Call Trees for the department and several extra staff signed in the Personnel Pool. Ensure each department has a call tree and the director maintains them adequately. Livingston Regional Hospital 17 Page

18 Riverview Regional Medical Center The team was able to get a large number of staff members in to assist with the disaster. Determine who will stay with child care, media, families, etc. Cookeville Regional Medical Center Staff procedure went well with call down list and web page ticker. Issue could evolve if all cell towers were destroyed by the tornado. Would suggest HAM radio exercises within the hospital to familiarize HAMS with facility. Macon County General Hospital Task # 3.2: Augment clinical staffing. Highlands Medical Center DeKalb Community Hospital Cumberland Medical Center Regional Medical Communications Center 18 Page

19 Plans are in place to collect staff from other areas in hospital to support ED in a mass casualty event. Jamestown Regional Medical Center Cumberland River Hospital The regional health coordinator is used to access a list of volunteers for the area. River Park Hospital Call Tree utilized. Livingston Regional Hospital Riverview Regional Medical Center The Command Center activated the roster and initiated the callback procedures for staff. Cookeville Regional Medical Center Great job. leadership add to some great discussion and staff allocations. Macon County General Hospital 19 Page

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21 Long-Term Care Facility Incident Command / Management System Performance Target Capability Activity # 1: Implement Incident Command / Management Associated Critical Tasks Task # 1.1: Staff establishes Incident Command / Management. Morningside Assisted Living of Cookeville Staff worked well together and was organized and prepared for this disaster Cedar Hills Senior Living NHC - Cookeville This has been established and recorded in handbook. New employees need to be oriented to the system. Plateau Mental Health Center Staff members were able to delegate responsibilities and complete needed tasks such as damage assessments and accessing safety of clients and staff. Staff members were knowledgeable regarding emergency procedures that would apply in this situation. Clear guide as to who would assume leadership roles on a weekend or evening shift when most supervisory staff members are not in facility. Ten Broeck Tennessee Recognizing the importance of having a leadership team to be able to secure the safety of the staff and patients. 21 Page

22 Celina Health and Rehabilitation Center More practice in establishing and maintaining Incident Command. Task # 1.2: Initiate and implement Incident Command / Management. Morningside Assisted Living of Cookeville Management team worked well together to implement the Incident Command Center At the next staff tornado / evacuation drill, review with staff the Command Center implementation to ensure they are aware of the responsibilities of the Incident Command Center. Cedar Hills Senior Living NHC - Cookeville Administrative staff members are knowledgeable of duties and able to initiate plan. Re-orient charge nurses in this area in the event the disaster occurs after normal business hours. Plateau Mental Health Center As noted, staff members were able to comply with emergency procedures as outlined in facility guide. Staff members were identified to handle appropriate tasks, clear timelines were established. Need to have chain of command for non-traditional office hours. Need to know how communication will be handled both internal and external during this time of emergency especially if utilities are disrupted. Also who would respond to family inquires that will occur regarding safety of clients and staff. 22 Page

23 Ten Broeck Tennessee Plans were made to be able to have this ready and in place during the disaster. Identifies the point persons to provide direction and make arrangements for additional staff coverage if needed. This enables the ability to triage the facility for structure, damage, access to food and water, unsafe environment and ways to evacuate to a safer location within the facility. Look at the smaller things such as maintaining a master list of contacts, an easily accessible census with the point person on shift. Provide additional training to support staff for effective response. Celina Health and Rehabilitation Center Again more practice with staff and practice with outside agencies to gain better understanding and comfort with ICS. Performance Target Capability Activity # 2: Communications Associated Critical Tasks Task # 2.1: A system of communicating timely and accurate information was established and maintained. Morningside Assisted Living of Cookeville Management and staff were notified in a timely manner Review the communication method and responsibilities with all staff at the next staff meeting to ensure all new staff understand Cedar Hills Senior Living Needs NHC - Cookeville 23 Page

24 Improvement A system was not in place for adequate communication from Incident Commander in the event that he was out of the center at time of disaster. Needs Improvement Will use cell phones at this time for communication and possibly look into an automatic message system to notify staff if disaster occurs. Plateau Mental Health Center Did not have a good plan for who would release information, how information would be reported to involved parties or what information could be released given confidentiality laws. Need to have clear guidelines as how above issues should be addressed. Ten Broeck Tennessee Recognizing the need to communicate with our host hospital which will include us in any communications with other disaster agencies. Also communication with the families of patients, staff, and public in regards to conditions and progress, damage reports. Would be more beneficial to participate in disaster training in a collaborative effort with host hospital to have a good disaster plan overall since they are responsible in our safety as well. Celina Health and Rehabilitation Center Good communication among staff overall. Possibly add radios so that staff and command have another form of communication with outside resources if needed. Performance Target Capability Activity # 3: Develop Incident Action Plan (IAP) Associated Critical Tasks Task # 3.1: Establish incident objectives, priorities and operational periods. 24 Page

25 Morningside Assisted Living of Cookeville Management team well aware of incident objectives, priorities and operational periods. Cedar Hills Senior Living NHC - Cookeville Systems and people in place to identify how to set priorities regarding resident placement, care and supplies during the incident. Establish a check system for supplies regularly to make sure they are adequate at all times. Plateau Mental Health Center Incident objectives where clear, priorities were established, not sure about "operational" periods. I don't know if during a disaster distinct periods will be that clearly delineated. You have the incident, the immediate aftermath, the then working to restore operations but much of that depends upon the speed of utilities being restored. Based on the information provided in the exercise, I believe the team did well. I would only recommend making a list of who would be notified to include contact numbers if services were disrupted for an extended period of time. Ten Broeck Tennessee Must work collaboratively with host hospital to determine what part of their overall plan is and how we need to respond according to their plan. Our plan should be to participate with them. Would be more beneficial to participate in disaster training in a collaborative effort with host hospital to have a good disaster plan overall since they are responsible in our safety as well. 25 Page

26 Celina Health and Rehabilitation Center Good job in establishing objectives and priorities. Become familiar with ICS forms. Performance Target Capability Activity # 4: Demobilize Operations Associated Critical Tasks Task # 4.1: Evaluate conditions to determine actions to be taken to demobilize operations. Morningside Assisted Living of Cookeville Administrator and Maintenance Director evaluated conditions and coordinated with other management team to demobilize operations and get residents and staff back to normal with the least possible disruption to residents and families. Cedar Hills Senior Living NHC - Cookeville Logistics Section Chief and Safety and Security officer are aware of action needed to be taken in the event of a disaster. Orient all staff in this area and make sure they are aware of staff in charge. Plateau Mental Health Center Team did a good job in this area. Able to identify the actions needed both internally and with external parties (such as State authorities) to resume normal operations. Would be good to have a clear plan regarding the provision of updates to all effected parties as to the current status of the 26 Page

27 facility and when return to normal operations is anticipated. Ten Broeck Tennessee Celina Health and Rehabilitation Center Good job in recognizing situation changes and when to begin demobilization process. 27 Page

28 SECTION 4: CONCLUSION 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. 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. Exercises are the most effective (and safer) means to: 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. 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. 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 participants are strong as well as identifying areas that the departments should invest future planning, training and exercise funds on. Hospital Medical Surge Activity Target Capability Performance # 1 Incident Management # 2 Increase Bed Surge Capacity # 3 Medical Surge Staffing Procedure Long-Term Care Facility Incident Command / Management System Activity Target Capability Performance # 1 Implement Incident Command / Management 28 Page

29 # 2 Communications # 3 Develop Incident Action Plan (IAP) # 4 Demobilize Operations 29 Page

30 APPENDIX A: IMPROVEMENT PLAN This Improvement Plan has been developed based on the results of Tennessee Twister - A Tornado Response Tabletop Exercise conducted on May 20, These recommendations draw on both the After Action Report and the After Action Conference. Hospital Improvement Plan Capability Observation Recommendation Responsible Agency Completion Date Incident Management Increase Bed Surge Capacity Medical Surge Staffing Procedure Incident Management Increase Bed Surge Capacity 30 Page

31 Long Term Care Facility Improvement Plan Capability Observation Recommendation Responsible Agency Completion Date Implement Incident Command / Management Communications Develop Incident Action Plan (IAP) Implement Incident Command / Management Communications Develop Incident Action Plan (IAP) 31 Page

32 APPENDIX B: PARTICIPANT FEEDBACK (Strengths Areas for Improvement) Hospital - Highlands Medical Center Review of plans. Discussion of available resources. Staff response. Hospital - DeKalb Community Hospital Improved critical thinking. Helped us identify deficiencies. Inter-agency cooperation. Strengths Hospital - Jamestown Regional Medical Center Involvement of staff in drill. Communication between community personnel and hospital staff. Identified opportunities for improvement. Hospital - Cookeville Regional Medical Center Open dialog with all participants. Discovered some opportunities that we can study and address. Made us think about resources needed that we had not thought of, during similar events. Hospital - Macon County General Hospital Teamwork and cooperation. Inter-agency cooperation. Open communications, all disagreements were resolved. Hospital - Regional Medical Communications Center Networking and talking through the event. Discovered some places for improvement. Hospital - Macon County General Hospital Teamwork and communication. 32 Page

33 Inter-agency communication. Cooperation between team members, disagreements were discussed and resolved. Hospital - River Park Hospital Good communication with EMS and EMA. Enough staff in labor pool. Amply amount of resources. Good organization on treatment plan. Hospital - Livingston Regional Hospital HICS supplies and tools. Participation and input. Open communication. Hospital - Livingston Regional Hospital Participation within group. The HICS supplies. Already had policies in place. Open communication. LTC Facility - Heritage Point Senior Living The groups ability to perform under pressure and perform well as a team. The individual team members understood their role and were able to perform their role as needed / expected. Each team member provided ideas, suggestions and actions in an open manner. All ideas were discussed and applied if applicable. Team members are not afraid to debate or discuss ideas. Hospital - Riverview Regional Medical Center Good Participation by everyone including the EMS Director. Immediate activation of Emergency Response. Utilizing resources. LTC Facility - Overton County Nursing Home We have ample space to relocate residents within the facility. We have a good first response in the event of a tornado in getting our residents out of initial harm. We have a sufficient food supply for an extended emergency. 33 Page

34 Hospital - Cumberland River Hospital Initiation of Code Black for Tornado warning. Initiation of Incident Command. Response of staff to the facility. MHC - Plateau Mental Health Center The team was aware of policies, emergency plans and continuity of care. We were client focused and safety focused. We recognized inter-departmental and inter-agency strengths. Hospital - Macon County General Hospital Team work and cooperation. Networking agencies. Hospital - Macon County General Hospital Everyone worked well together and good communications. Everyone participated and seemed to enjoy. Our plan seems to be good in what we have set-up. Hospital - Macon County General Hospital Teamwork and Cooperation. Cooperation of agency. MHC - Plateau Mental Health Center Staff participating in the exercise were well informed of policies and procedures. Communication within the group was good and we had a good exchange of ideas. Insight gained as a result of the exercise - it was very helpful tool to identify the areas needing improvement in our current procedures. LTC Facility - NHC - Cookeville Players were willing to be active in the "game". The exercise provided guidance as we worked through potential issues. Hospital - Cumberland Medical Center Staff participation. Our current policies covered all aspects of the drill - Yea! Recovery process went well. 34 Page

35 LTC Facility - Morningside Assisted Living of Cookeville Went well. LTC Facility - Morningside Assisted Living of Cookeville The whole team worked together and all had the same conclusion. This exercise made the whole team review our disaster plan and make sure it was up to date The whole exercise was well structured. LTC Facility - Morningside Assisted Living of Cookeville Moving the residents to safety. Assessed for nursing issues. Safe and timely evacuation. LTC Facility - Morningside Assisted Living of Cookeville Notification of management team and staff went well. Evacuation of residents went well. All team members were aware of their roles. Every one aware of their roles and were able to act in a timely and appropriate manner. LTC Facility - Morningside Assisted Living of Cookeville Appropriate alert system in place for facility. Notification of staff members went well. All members of team were aware of responsibilities during this disaster. Implementation went well. Evacuation planning and implementation went well. All team members were quick and knowledgeable in response. LTC Facility - Cedar Hills Senior Living The warning signals were working well and gave time to prepare for the situation. Residents were calm and followed direction easily. The staff responded appropriately and knew how to handle the situation. Hospital - Cookeville Regional Medical Center Good collaboration with all team members and good communication. Identified areas we could improve our processes. MHC - Plateau Mental Health Center We worked well together as a team in generating ideas and looking at how we can cooperate in an emergency. 35 Page

36 Staff had a good knowledge of the policies involved of our facility for emergencies. Our group leader was good at summarizing the best aspects of our suggestions. LTC Facility - Morningside Assisted Living of Cookeville Moved to safe location. First Aid. Inventory of supplies. Hospital - River Park Hospital Communication between EMS, EMA and and the hospital. Staffing / labor pool. Achieved measurable outcome. MHC - Plateau Mental Health Center Informing everyone of a tornado warning. All staff work together very well. Knowledge of our policies. LTC Facility - Cedar Hills Senior Living Completing the exercise with another facility in the area brought their perspective and procedures into our discussion which was helpful. Recent ice storms and our response to those issues helped us with this tornado exercise. Discussing staff and resident stress as well as staff exhaustion was helpful to our facility staff. Hospital - Cumberland River Hospital Activation of Code Black in our Safety Plan for Tornado. Activation of Incident Command. Response of staff in Emergency Disaster Situation for influx of patients. Hospital - Riverview Regional Medical Center We responded quickly and the Incident Commander started assigning roles to each individual. We knew, without delay our current situation with inpatients, possible discharges and how to expedite those and cancelled any elective procedures for today. We worked as a team to brainstorm ideas and suggestions. 36 Page

37 Hospital - Riverview Regional Medical Center Incident Command initiating Disaster Code. Call tree activated for staff / directors. Utilization of resources: staff, supplies / equipment, etc. LTC Facility - Overton County Nursing Home Very prepared for what to do before a tornado hits to protect residents and staff. Communication. Dietary was very well stocked for emergency. Hospital - River Park Hospital Good communication with County EMS and EMA. Ample amount of resources, assets and personnel. Good organization on treatment plan. LTC Facility - Overton County Nursing Home Initial response. Facility had disaster plan in place. Available space in facility to move residents should an area of facility become damaged. Hospital - Livingston Regional Hospital Incident Command Center tools (packets / vests for each role and mapping board). This exercise identified some potential circumstances that our current policies do not address. Made you address issues you don't necessarily think of when writing policies. Hospital - Highlands Medical Center Implementation of our emergency operations plan. Team coordination of the processes. Communication among team members. Hospital - Livingston Regional Hospital Communication. Teamwork. Response Times. 37 Page

38 LTC Facility - NHC - Cookeville All team members were present and prepared. Team members participated, gave input and identified areas for need of improvement. Kept on tract and met time frames given. Also identified areas that we already have in place and that are working. Hospital - Livingston Regional Hospital The details of the drill were helpful. Hospital - Livingston Regional Hospital Great communication. Hospital - Livingston Regional Hospital Great leaders in our group. Policies and procedures were well thought out. Hospital - Riverview Regional Medical Center Having the specific manuals to review and guide was a great help. Co-ordination between departments at facility was very helpful. Notification and reaction from our parent supply source. Had filed with them a "QUICK RE-SUPPLY LIST" of items generally needed during an incident such as this which reduced the replenish effort if needed. Hospital - Riverview Regional Medical Center Worked good together as a team. Thought the exercise was very good. The exercise was a good experience for staff. LTC Facility - Cedar Hills Senior Living Good notification procedures. Residents were calm and cooperative. Preparing for all possibilities. MHC - Plateau Mental Health Center The team worked well together. The team was knowledgeable about the policy and procedures that are in place. The agency works well with other agencies and within themselves. Hospital - Livingston Regional Hospital 38 Page

39 Good attendance. Stayed on track with the exercise. MHC - Plateau Mental Health Center We worked as a team. We work well with other agencies and within the volunteer system. The team was knowledgeable about moving clients to a safe place while keeping them as calm as possible. The team members were focused on attending to the needs of the clients, as well as staff. Hospital - Cumberland River Hospital Initiating Code Black which occurs when county is placed under a tornado warning. Initiating Incident Command. Call list activation and staff response. Hospital - Highlands Medical Center Response of staff. Management of resources. SMART triage system being recognized throughout emergency services in the community. Hospital - Livingston Regional Hospital Having the EMA director onsite to critique the exercise. LTC Facility - Overton County Nursing Home We have ample space to relocate residents within the facility. We have a good first response in the event of a tornado in getting our residents out of initial harm. We have a sufficient food supply for an extended emergency. LTC Facility - Overton County Nursing Home We have ample space to relocate residents within the facility. We have a good first response in the event of a tornado in getting our residents out of initial harm. We have a sufficient food supply for an extended emergency. LTC Facility - Overton County Nursing Home We continue to have a sufficient food supply. 39 Page

40 We have space for relocation in the event we need to evacuate a particular area. Our first response in making the facility safe is good. LTC Facility - Overton County Nursing Home We have ample space to relocate residents in the facility. We have a good first response in the event of a tornado in getting our residents out of initial harm. We have a sufficient food supply for an extended emergency. LTC Facility - Cedar Hills Senior Living Good to have different ideas from other facilities. Working well with local emergency planning committee. Knowing different people to get in touch with in a disaster. MHC - Plateau Mental Health Center Appeared that the team put the emotional and physical needs of clients ahead of anything else during the exercise. Team was able to identify who would take on what roles despite it not being clearly designated in written emergency procedures. Team was clearly able to identify necessary parties to contact regarding disruption in services. Hospital - Livingston Regional Hospital Members were as organized as could be in such a drill and all worked collaboratively to sole the issues as they arose. Sound leadership from all agency heads during the exercise. Team members concluding the exercise encouraged one another to improve upon their known and found deficiencies. Hospital - DeKalb Community Hospital Activation of HICS team. Deployment of call list. Transfer and transport to medical surge of patients. Hospital - Riverview Regional Medical Center Great participation. Mass call to employee's. 40 Page

41 Utilized resources. MHC - Ten Broeck Tennessee Being able to recognize the issues present to triage the process of safety and care for the patients. Able to recognize process of communication with host facility. Ability to set up care and determining what portions of programming to pause and what crisis interventions to be made. Hospital - Cookeville Regional Medical Center Leadership knowledge, decision making and HICS implementation. Community responder communication and understanding. Interpersonal relationship long standing in community. EOP and annex plans were flowed. Plans in each area of hospital as well as on shared drive so forms are easily accessible to all Hospital - Livingston Regional Hospital Organization of the Emergency Department. Organization of safety. Organization of finance. LTC Facility - Heritage Point Senior Living Our team worked very well together and I believe that to be a very strong statement as to how we operate daily. Hospital - Macon County General Hospital Participants were engaged and active with the drill. All members present were very knowledgeable regarding our hospital's policies and protocols. LTC Facility - Heritage Point Senior Living All Chiefs and Officers understood what their job duties were. All Chiefs and Officers were good communicators with each other in discussing the needs of each area that needed help. The employees and officers were willing to work in other areas and delegate responsibilities to those that needed direction. LTC Facility - Heritage Point Senior Living The team understood individual role play. 41 Page

42 Everyone worked very well together and recognized each others duties. The entire team learned from this exercise. Listening to each individual input and suggestions was remarkable. Hospital - Riverview Regional Medical Center Good participation. Everyone showed interest. Renewed our base knowledge; we have it in our minds, but without the practicing it leaves us. Hospital - Highlands Medical Center Restocking of resources. Addressing pediatric needs in our plan. Community updates and public relations. Hospital - DeKalb Community Hospital Identification of children. Areas for Improvement Written diversion policy for the Emergency Department. Better plan for downsizing. Hospital - Jamestown Regional Medical Center Improved emergency call system to notify staff. Need to establish agreement with an off site location for family to seek information regarding victims Improve our process for identifying patients with no identification and children of incident - especially for those transferred. Hospital - Cookeville Regional Medical Center How to communicate to outside if we have lost all communications. Detailed plan for reunification needed, especially for pediatrics. Need additional help for traffic control in ER parking lot. As well as within the facility. Hospital - Macon County General Hospital Adding diversion policy to EOP. Better identification of unknown pediatric patients. Hospital - Macon County General Hospital Diversion added to EOP. 42 Page

43 Improving identification of unknown pediatric patients. Hospital - River Park Hospital Staff notification. Security plan / crowd control. Develop a reunification plan - children with parents. Hospital - Livingston Regional Hospital Access, location and knowledge of supplies. Communication. Identification and tracking of patients. Hospital - Livingston Regional Hospital Location and knowledge of supplies. Communication internal and external. Identifying and tracking the influx of patients. LTC Facility - Heritage Point Senior Living The policy and procedures manuals will need to be updated, revised and expanded. The current book and expanded policies will need to be reviewed and a simulated drill will be conducted as a required staff training with all associates. Furthermore, the policy about social media shall be reviewed with staff to included discussion about appropriate comments. Review that no one should communicate about the status of building or residents except for the designated representative. All staff should have a copy of the phone tree in their possession either in their personal phone or the paper phone tree. Reviewing all emergency procedures with the residents. To include discussion and roleplaying of actual emergencies. We practice fire drills monthly and other drills quarterly as required by the state. We will expand monthly drills to include other emergency drills. We will practice Tornado drills frequently. Remind residents and family members of the importance of remembering to sign in and out when leaving / arriving building. Hospital - Riverview Regional Medical Center Plan updating to include pediatrics. Updating designation sites for family, media, etc. Communication. LTC Facility - Overton County Nursing Home We needed to add a "Damage Assessment" form and the "Personnel Log" form. 43 Page

44 We need to re-address our water loss protocol. We need to increase our store of personal care supplies. Hospital - Cumberland River Hospital Education to facility staff on the SMART Tag System and the Triage Log. Diversion Plan located in Emergency Department Policy and Procedure Manual should be placed in the facility's EOP. EOP should have a more detailed demobilization plan with reference to needed actions. MHC - Plateau Mental Health Center Develop a formal plan for a tornado watch. We have plan for a tornado warning but not a tornado watch. Develop and implement a policy for incident command and refine current emergency response procedures to include onsite command. Improve methods of notifying staff of environmental emergencies. Improve family preparedness. Hospital - Macon County General Hospital Transferring one policy into another. Identification of children. Hospital - Macon County General Hospital Change location of policy. Identification of children that have no parents with them. Hospital - Macon County General Hospital Transferring location of one policy into another policy. Identification of children brought in without a parent of guardian. MHC - Plateau Mental Health Center We recognized the need for encouraging family preparedness - we often fail to recognize the responder / provider needs. Improved means of communication internally and externally. Clearer delineation of action to be taken during a watch vs warning and more detailed direction for guidance in the event there are damages. LTC Facility - NHC - Cookeville New partner should be effective oriented to our EMP. Awareness and education of EMP should be improved with all personnel. 44 Page

45 We need to as a group develop an incident command center. Hospital - Cumberland Medical Center Need more reliable communication from the scene. Need better process for identifying medical volunteers who may show up to help in a true disaster. Education of Wellness Center staff in conjunction with reuniting families if separated (several new staff members at that facility including manager). LTC Facility - Morningside Assisted Living of Cookeville Educate staff on the Incident Command System. Update roster with current contact information for families. Storing emergency supplies in more than one area so that if an area is damaged, the other area may still be accessible. LTC Facility - Morningside Assisted Living of Cookeville Resident rooster should be updated and revised. Protocols reviewed and revised as needed. Ensure all staff have correct and updated telephone numbers for contact in emergency. LTC Facility - Morningside Assisted Living of Cookeville Review and revise resident roosters. Review, revise and update all contact numbers for residents and staff. Review and revise disaster protocols. LTC Facility - Cedar Hills Senior Living Make a contact list of resident families or other volunteers that could be called in to facility to assist during a disaster situation. Do reminders to all staff on how to turn off all utilities for protection of facility and residents. Be better prepared for media response to situation. Hospital - Cookeville Regional Medical Center Improve our patient unification system, especially for pediatric patients. Need to look at procedures if no phone if available how we would contact staff and formalize this plan. MHC - Plateau Mental Health Center We need to develop a facility policy for tornado watches even while we already have 45 Page

46 one for tornado warnings. We need more total practice for staff as a whole to understand and use our emergency policies. Facility / company policy needs to be clearer about who speaks for the facility in an emergency. LTC Facility - Morningside Assisted Living of Cookeville Organization. Added transportation. Additional supply storage. Hospital - River Park Hospital Calling tree communication. Create policy regarding children / emergency. Streamline process / policies. MHC - Plateau Mental Health Center Need to improve informing everyone of a tornado watch. Need to improve Incident Command System. Need to improve preparing families. LTC Facility - Cedar Hills Senior Living Addressing filming and photographing of disaster damage for insurance companies is not addressed in our policies and needs to be added. It seems that we have relied heavily on one person for much of response to families, local emergency officials and staff and that system needs to be addressed. We plan to have assistants available for delegation of duties at all times. Use of disposable incontinence supplies rather than traditional pads during an emergency should be added to our plan. Hospital - Cumberland River Hospital Educate Staff on Smart Tag System. Place Diversion Plan located in the Emergency Department in the EOP. Address details for demobilization in our EOP more clearly. Hospital - Riverview Regional Medical Center Our EOP should be more specific to each department and where to place families, media and child care. 46 Page

47 Hyperreach System. HAM radio? Does Mr Payne still do this? Where is ours? Hospital - Riverview Regional Medical Center To have white board in conference room (Incident Command Center) to scribe and make notes. Communications can always be improved. Updating of EOP. LTC Facility - Overton County Nursing Home More improvement on what to do after a tornado hits, what steps to take next. Making sure enough water is available for a prolonged period of time. Continue to make improvements on contacting individuals. Hospital - River Park Hospital Directors need to familiarize themselves with policies and procedures. Add in plan when to reunite children with parents. Re-education of new directors of HICS process, assignments, etc. LTC Facility - Overton County Nursing Home Increase water supply that facility has on hand. Increase personal care products supply. A log to keep up with hours that employees work. Hospital - Livingston Regional Hospital Making additions to current disaster plan in regards to identifying children that are not with parents. Don't need to change location of designated areas such as manpool area without clear communication to all staff. Don't just change a policy and not communicate the changes. We have associates that have been at this facility for many years and certain terms and designated locations are the CULTURE here. My fear is that if we start changing names of processes and changing locations that staff will be confused during a real event. Have a policy manual (printed copy) for the Facility Operations and Safety / Environment in the Command Center. Hospital - Highlands Medical Center Availability of resources and the ability to restock quickly. 47 Page