After Action Report / Improvement Plan

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1 After Action Report Improvement Plan Resolute Response A Shelter Operations Functional Exercise June 18, 2013 DMINISTRATIVE HANDLING INSTRUCTIONS Florida Department of Health in Sumter County Bushnell Florida 1 Page

2 ADMINISTRATIVE HANDLING INSTRUCTIONS 1. The title of this document is The "Resolute Response - A Shelter Operations Functional Exercise - Sumter County" 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: Health Department: Walter Thomas Florida Department of Health in Sumter County (Office) ( ) Exercise Director: Chris Floyd Disaster Resistant Communities Group LLC (Office) ( ) 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... 6 Exercise Purpose and Design... 6 Exercise Objectives, Capabilities and Activities... 6 Scenario Summary... 6 SECTION 3: ANALYSIS OF CAPABILITIES... 6 SECTION 4: CONCLUSION APPENDIX A: IMPROVEMENT PLAN APPENDIX B: PARTICIPANT FEEDBACK (Strengths Areas for Improvement) APPENDIX C: ACRONYMS Page

4 EXECUTIVE SUMMARY Resolute Response - A Shelter Operations Functional Exercise - Sumter County was designed and facilitated to analyze the strengths and weaknesses of Sumter County s shelter operations plans and procedures via a series of informational scenarios and injects. These scenarios and injects dealt with subjects such as assigning appropriate staff to support shelter operations to appropriately discharging individuals during the shelter demobilization process. 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: Resolute Response - A Shelter Operations Functional Exercise - Sumter County Tabletop Exercise Start Date: June 18, 2013 Duration: Location: Sponsor: Three Hours Sumter County Florida Department of Health in Sumter County Purpose: The primary purpose of this exercise was designed and facilitated to analyze the strengths and weaknesses of Sumter County s shelter operations plans and procedures via a series of informational scenarios and injects. These scenarios and injects dealt with subjects such as assigning appropriate staff to support shelter operations to appropriately discharging individuals during the shelter demobilization process. Scenario Type: Hurricane Participant Information Participant Location American Red Cross Sumter County Emergency Management Department Sumter County Fire and EMS Department Sumter County Health Department Sumter County Medical Reserve Corps Wildwood Community Center Number of Participants 21 5 Page

6 SECTION 2: EXERCISE DESIGN SUMMARY Exercise Purpose and Design The primary purpose of this exercise was designed and facilitated to analyze the strengths and weaknesses of Sumter County s shelter operations plans and procedures via a series of informational scenarios and injects. These scenarios and injects dealt with subjects such as assigning appropriate staff to support shelter operations to appropriately discharging individuals during the shelter demobilization process. 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: Shelter Operations Activity Target Capability # 1 Direct Operations # 2 Activate Shelter Operations # 3 Establish Shelter Operations # 4 Manage Shelter # 5 Close Shelter Scenario Summary It is mid-august and local citizens have been complacent in their hurricane preparedness activities because this year's hurricane season has not even seen its first Tropical Storm. Families are making their last minute plans for their summer vacations while local business owners are thinking that the hurricane season could be very inconsequential. However weather forecasters are predicting a major change in the atmosphere that could see a sharp increase in the number and severity of hurricanes within the next few weeks. 6 Page

7 By late August local residents and business owners begin to follow the projected path of the season's first Tropical Storm. Soon the storm strengthens into Hurricane Alex as it continues its forward movement. The National Hurricane Center continues to monitor the storm via satellite and Hurricane Hunter planes as it continues to intensify. Hurricane Alex has stayed true to the course that has been predicted by the National Hurricane Center and has grown into a mid-sized category two storm. During the previous 24 hours the forward movement of Hurricane Alex has increased and the National Hurricane Center has now posted a Hurricane Watch along the coastline indicating that the storm should be making landfall within the next 24 to 36 hours. 7 Page

8 SECTION 3: ANALYSIS OF CAPABILITIES Shelter Operations Performance Adequate Activity # 1: Direct Operations Target Capability Associated Critical Tasks Task # 1.1: Activate Shelter Plans. DOH - Yes, ARC -Yes, School Board -Yes Suggest looking at time frames for implementing shelter operations. Adequate Evaluator # 2 The plan activation was discussed thoroughly. Continue to have staff become familiar with the plan every chance they get so they get comfortable with the Special Needs Shelter Operations. Task # 1.2: Designate site(s) to serve as shelter(s). The county is in the process of evaluating shelter locations. Will impact current shelter list. Some shelter locations will get taken off the list. Strong Evaluator # 2 David Costa did an excellent overview as to how the shelters are selected. Continue to evaluate the shelter locations as changes come about. 8 Page

9 Task # 1.3: Conduct initial and on-going needs assessment of individuals with regarding sheltering operations. Weak Evaluator # Special Needs Shelter clients triaged, another 200 still to be triaged by health department. Those 200 individuals need to be triages ASAP, as we are in hurricane season right now. Suggest coming up with a plan for Special Needs Shelter call down, complete with timelines, roles and information sharing. Adequate Evaluator # 2 The discussion indicated that individuals in manufactured / mobile homes and low lying areas would most likely be candidates for Specials Needs Sheltering along with an annual call down of people registered. The 1,500-1,800 projected evacuees may be streamlined if home health care agencies were an active part of the registration discussion. Task # 1.4: Ensure appropriate internal and external communication systems are available. Strong Evaluator # 2 The discussion indicated a redundancy in communication systems. Task # 1.5: Activate vendor agreements / Memoranda of Understanding (MOUs) / Memoranda of Agreement (MOAs) in support of Shelter Operations. Weak Evaluator # 1 There is an MOU between DOH, MRC and ARC to share MRC 9 Page

10 nursing staff. There are no other agreements between county and anyone regarding shelters. Suggest seeking backup plan for medical staff; as MRC is a volunteer organization and in an impacted area, those volunteers are also impacted and may not be available. Weak Evaluator # 2 The Special Needs Shelter operations in the past were accomplished with verbal agreements since the community partners were very involved and familiar with the processes of sheltering. The corporate knowledge is slowly becoming obsolete. New agency representatives may not have the experience or knowledge of the verbal agreements. As changes are occurring and new faces are starting to show up at community meetings the need for written agreements are becoming essential to a smooth Special Needs Shelter in the time of a shelter activation. Written agreements should be in place for future disasters or emergency events so community partners know what to expect. Task # 1.6: Disseminate appropriate, accurate and timely information to the public, media, support agencies and vendors about Shelter Operations. Emergency management starts communicating with partners when storm is 5 days out. Strong Evaluator # 2 The discussion indicated that timely information was distributed to ensure the public knew what to expect as the storm or disaster was projected. Personnel did this to keep rumors from circulating which would be time consuming to correct. Keep providing timely information to the public on an as needed basis so as to not overwhelm them but keep them focused on the emergency messages. 10 Page

11 Performance Target Capability Adequate Activity # 2: Activate Shelter Operations Associated Critical Tasks Task # 2.1: Notify and mobilize trained shelter staff and management. DOH has staff trained specifically for Special Needs Shelter operations. ARC has previously trained staff and starts Just in Time training 5 days out. School District also trains staff in shelter operations each year. ICS training consistently used throughout county. DOH will start looking at staff availability (leave, vacation, etc.) 3 days out. Can cancel leave if needed. Do logistics to prepare for Special Needs Shelter opening just in case. Touch base with hospital to see census status. Sheriff's Office also contacts staff to deal with family preparedness early as staff will be too busy close to storm. Center Hill Recreation Center and Wildwood Community Center depending on ARC entirely for food, no facilities at these locations for preparing food. Also no other staff support from county. Strong Evaluator # 2 The call down procedures seemed to be strong across the community partners. Training also seems to be on-going as well. Continue to train personnel on Special Needs Shelter operations as people become assigned to emergency duty. Task # 2.2: Mobilize needed shelter resources (equipment, consumable supplies, etc.). DOH has a cache of shelter equipment (cots, med supplies, 11 Page

12 etc.) and would be checking these supplies 3 days out. ARC has regional cache not county, some cots for functional needs but this would be post storm, not evacuation shelters. County Animal Services has cache for pet shelter. But know they don't have sufficient kennels if lots of dogs come. Schools use what is on hand in the school inventory only 2 to 3 days of supplies during summer months but could move food around. Continue to plan for emergency management for storage. Suggest shifting supplies between agencies. Strong Evaluator # 2 The community partners seemed to be in sync with each other and have a smooth transitional process for obtaining resources and supplies for an activation. Continue to develop the positive relationships and expectations amongst community partners in regards to obtaining resources and supplies. In addition, written agreements should be established to ensure the timeliness of the resources when needed. Performance Target Capability Adequate Activity # 3: Establish Shelter Operations Associated Critical Tasks Task # 3.1: Conduct building / facility inspection. Strong Evaluator # 1 Done ahead of time. Pre-identified. Adequate Evaluator # 2 It seemed like only a few people knew that a walk thorough was conducted. Ensure personnel are aware that a walk thorough is conducted so if they find discrepancies they may be included in the report. 12 Page

13 Task # 3.2: Staff shelter with appropriately trained personnel. Weak Evaluator # 1 Each sheltering agency seems to have a training program for staff. ARC does not know numbers and if it could staff the 4 general population shelters. Animal Services would be stressed with limited staff. GAP identified Lack of any nursing staff in general population shelters. DOH could staff for 2 to 3 days then MRC would be used. Adequate Evaluator # 2 Special Needs Shelter had just conducted training with the Florida Department of Health and an exercise was conducted a couple of weeks ago to refresh Special Needs Shelter operations. As new personnel come on board recommend continued training opportunities. Task # 3.3: Set up shelter for operations. Strong Evaluator # 2 Community partners indicated there was a broad spectrum of both inexperienced and well experienced personnel. The overall sense of readiness seemed to be positive especially after the discussion of what to expect. Continue to training at every opportunity. Task # 3.4: Coordinate provision of shelter support services with appropriate agencies (e.g., food service, security, etc.). 13 Page

14 EMS / Fire Department cannot support shelters with units stationed there. Obviously would respond if called and wind were not high. Potential GAP identified: Dependence on ARC only for food and lack of facilities staff at Center Hill Recreation Center and Wildwood Community Centers exists among exercise participants on this issue. Weak Evaluator # 2 Care beyond Special Needs Shelter operations was a hot discussion. Here again, written agreements should be in place on what or which clients would need to be places based on the registry and walk in clients. Care beyond Special Needs Shelter operations should be discussed more in depth with health and medical community partners along with home health care agencies sooner than later. Performance Target Capability Adequate Activity # 4: Manage Shelter Associated Critical Tasks Task # 4.1: Conduct population registration. Adequate Evaluator # 2 Although registration is an on-going process year round. This is still those individuals who will not self identify their special needs until the disaster is on their doorstep. The emergency management seems to have an adequate process and they understand they are only getting cooperation from some of the population. Continue to educate the general population regarding special 14 Page

15 needs at every available opportunity. Task # 4.2: Provide medical care to population. Weak Evaluator # 1 GAP identified There are a limited number of nurses in the area. Develop several back up sources of medical folks and request help early. Adequate Evaluator # 2 A discussion was held during the exercise regarding the medical provisions available and what to do with clients who may show with care requirements beyond the Special Needs Shelter capability. There are no written agreements with the EMS or medical facilities to acquire the clients during emergencies. It is simply understood that if something bad happens. The collective personnel will review and act on each and every case individually. A more in-depth discussion needs to take place regarding care beyond the Special Needs Shelter and written agreements should be established. Task # 4.3: Provide feeding and bulk distribution services appropriate to shelter population. School District and ARC will provide. Strong Evaluator # 2 The Emergency Management, ARC and the School District have a plan to adequately stock and distribute supplies. There should be written agreements established. Task # 4.4: Request resources and equipment needed to support population. 15 Page

16 Requests would go through county EOC and would be done early if needs are known. Adequate Evaluator # 2 Participants understood the process to request resources and equipment to support the population. Staffing may be issues with increased population requirements. EMS may be in the shelter but will be separated from the main area so they do not become the primary medical resource. Continue to evaluate Special Needs Shelter staffing as the registration and potential client numbers increase. Perhaps engage in discussions with home health care to discuss level of care the home health care agencies intend to provide for their normal clients. Performance Target Capability Adequate Activity # 5: Close Shelter Associated Critical Tasks Task # 5.1: Conduct Discharge Planning in coordination with appropriate agencies and organizations. Weak Evaluator # 1 Florida DOH and ARC have discharge planning teams. Further identify county support needed for discharge planning. Adequate Evaluator # 2 Only a few individuals were aware of the process for discharge planning. Perhaps discharge planning training could be conducted with community partners to obtain a better understanding and to provide a smooth transition to our clients. Home health care should be included in this discussion. 16 Page

17 Task # 5.2: Disseminate notification to close shelter operations. Adequate Evaluator # 2 Emergency management will announce shelter closing. 17 Page

18 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 Sumter County is strong as well as identifying areas that the departments should invest future planning, training and exercise funds on. Shelter Operations Activity Target Capability Performance # 1 Direct Operations Adequate # 2 Activate Shelter Operations Adequate # 3 Establish Shelter Operations Adequate # 4 Manage Shelter Adequate # 5 Close Shelter Adequate 18 Page

19 APPENDIX A: IMPROVEMENT PLAN This Improvement Plan has been developed specifically for Sumter County based on the results of Resolute Response - A Shelter Operations Functional Exercise - Sumter County conducted on June 18, These recommendations draw on both the After Action Report and the After Action Conference. Capability Observation Recommendation Responsible Agency Completion Date Only half of the registered Special Needs clients have been triaged. Complete triage process and remain current on future Special Needs client registration. Direct Operations There is a total lack of any written MOUs among the agencies and organizations responsible for shelter operations within the county. Develop and execute MOUs among appropriate shelter support agencies and organizations. There is a lack of health care staff to effectively support shelter operations within the county. Continue to identify and recruit individuals and agencies that can support the health care needs of shelter clients. Activate Shelter Operations Adequate shelter activation procedures appear to be in place. at this time. Establish Shelter Operations While agencies and organizations have the Continue to identify, recruit and training agency staff 19 Page

20 trained staff to open shelters there appears to be a lack of staff to sustain shelter operations past the first 2 to 3 days. and volunteers in the operations of shelters. Local home health care agencies are not involved in supporting shelter operations. Work with these organizations to encourage them to provide staff to support their clients that have been evacuated to the Special Needs Shelter. Manage Shelter Currently it appears that there is not a plan for dealing with evacuees that required medical assistance beyond the level available at the Special Needs Shelter. Develop a set of guidelines to address this issue. Close Shelter There appears to be a lack of local capabilities regarding Discharge Planning for clients of the Special Needs Shelter. Review the Florida DOH guidelines for Discharge Planning then identify and engage local resources to support this activity. 20 Page

21 APPENDIX B: PARTICIPANT FEEDBACK (Strengths Areas for Improvement) Strengths The exercise was well organized. The instructors were good. Good constructive discussion and interaction between agencies. Progress made towards recognizing and finding solutions for areas needing strengthened and / or corrected altogether. ONX System function. Easy to follow, understand. Also flowed well. Good setting with participants close enough to engage in conversation. Understanding different agency commitments, perceptions and expectations through discussion. It brought a variety of partners together to dis cuss readiness for response. Identification of gaps in plans and need to update existing plans. Identification of how informal the county agency plans really were. Participants attended and participated well with each other. The number of community partners at the exercise was outstanding. It allowed for good discussions which provided a better understanding of what to expect. Each community partner described what to their roles and responsibilities were and what they brought to the table to ensure a successful shelter operation. In addition, the partners share some of the on-going initiatives in the works to improve service to the community during a disaster and or emergency. Misconceptions were corrected which increased the likelihood of a successful operation. Some gaps were identified so we can work on them prior to shelter activation. Areas for Improvement All local agencies significantly involved in disaster should participate and / or send the best representative possible. Development of MOU's between government and non-government entities. Identify non-traditional partners who could become part of the system. Creation of a volunteer identification base and the development of just in time training. 21 Page

22 Medical staffing may be an issue. Home health care agencies should be part of this discussion as they are mandated by Florida Statutes to perform the same quantity of care in the special needs shelter as in the home setting. 22 Page

23 APPENDIX C: ACRONYMS Acronym Meaning ARC COMM CONOPS EOC ESF IAP IC ICS IMT JIC LOFR MOA MOU MRC NIMS OPS PIO SERT SitRep SOG SOP SpNS UC American Red Cross Communications Concept of Operations Emergency Operations Center Emergency Support Function Incident Action Plan Incident Command Incident Command System Incident Management Team Joint Information Center Liaison Officer Memorandum of Agreement Memorandum of Understanding Medical Reserve Corps National Incident Management System Operations Public Information Officer State Emergency Response Team Situation Report Standard Operating Guideline Standard Operating Procedure Special Needs Shelter Unified Command 23 Page

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