After Action Report / Improvement Plan

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1 After Action Report Improvement Plan Columbia Chemical Calamity A HazMat Response Full-Scale Exercise February 20, 2014 Columbia County Emergency Management Department 1 Page

2 ADMINISTRATIVE HANDLING INSTRUCTIONS 1. The title of this document is The "Columbia Chemical Calamity - A HazMat Response Full-Scale 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: County Emergency Management: Shayne Morgan Columbia County Emergency Management Department (Office) # 2 ( ) shayne_morgan@columbiacountyfla.com 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... 8 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 Columbia Chemical Calamity - A HazMat Response Full-Scale Exercise was designed and facilitated to assess the capabilities of local agencies to respond to a hazardous materials incident occurring within the county. 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 Core Capability with its associated Major Strengths, Primary Areas for Improvement and Improvement Recommendations 4 Page

5 Exercise Details SECTION 1: EXERCISE OVERVIEW Exercise Name: Type of Exercise: Columbia Chemical Calamity - A HazMat Response Full- Scale Exercise Full-Scale Exercise Start Date: February 20, 2015 Duration: Location: Sponsor: Three Hours Lake City Florida Columbia County Emergency Management Department Purpose: The purpose of the exercise was to assess the capabilities of local agencies to respond to a hazardous materials incident occurring within the county. Scenario Type: Hazardous Materials Participant Information Participant Agencies / Organizations Century Ambulance Inc City of Lake City Fire Department City of Lake City Police Department City of Macclenny Fire Department Columbia County Combined Communications Center Columbia County Emergency Management Department Columbia County Fire Rescue Department Columbia County Sheriff's Office Columbia County Tourist Development Office Florida Department of Environmental Protection Florida Department of Health 5 Page

6 Florida Department of Health - Columbia County Florida Fish and Wildlife Conservation Commission Florida Gateway College Florida Highway Patrol Lifeguard Ambulance Services Salvation Army Number of Participants 91 6 Page

7 SECTION 2: EXERCISE DESIGN SUMMARY Exercise Purpose and Design The purpose of the exercise was to assess the capabilities of local agencies to respond to a hazardous materials incident occurring within the county. 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 Core Capabilities List. 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: Citizen Notification Activity Core Capability # 1 Notification Implementation HazMat Response and Decontamination Activity Core Capability # 1 Site Management and Control # 2 Identify the Problem # 3 Select Personal Protective Clothing and Equipment # 4 Implement Response Objectives On-Site Incident Management Activity Core Capability # 1 Establish and Maintain Full On-Site Incident Command # 2 Develop Incident Action Plan (IAP) Public Safety and Security Response Activity Core Capability 7 Page

8 # 1 Activate Public Safety and Security Response # 2 Command and Control Public Safety and Security Response Operations # 3 Control Traffic, Crowd and Scene Scenario Summary It s the end of the semester at Florida Gateway College and graduation is right around the corner. The stress level of many of the students is rather high as this is final exams week. In Dr Smith s Chemistry class, two seniors, Greg Bird and Gary Sanchez, are extremely concerned that they didn t study enough for the final and that they will fail. If they fail they will not be allowed to graduate. When Dr Smith walks out of the room to talk with a fellow instructor, the two friends quickly run into the chemical storage room. They find a few chemicals out in the open and decide to mix them together. Their goal is to cause some smoke to be generated so that the final will be suspended and that classes will be cancelled for the rest of the day. As soon as they start mixing the chemicals together in the sink a violent reaction occurs causing an explosion and setting fire to the classroom. Throughout the campus students are panicking as many believe that the explosion could have been the beginning of an assault on their school. As the campus wide fire alarm goes off students begin an un-controlled rush to evacuate campus buildings. 8 Page

9 SECTION 3: ANALYSIS OF CAPABILITIES Citizen Notification Performance Adequate Core Capability Activity # 1: Notification Implementation Associated Critical Tasks Task # 1.1: Based on the need to evacuate or shelter-in-place determine the affected and / or at-risk-population that will need to be notified. Recommendations The college determined that the entire database of the notification system would be used, making sure all staff and students were alerted to the incident. This allowed for a more accurate and complete notification to keep everyone apprised of the situation. I didn't see any need to adjust the scope of the notifications for the college. All faculty and students needed to know of the incident and take the proper actions. I would recommend that the college continue to add members to their system i.e. surrounding business and residents so they too can be notified of any incidents. Task # 1.2: Prepare appropriate messaging to be delivered via various citizen notification systems. The college did a good job alerting its faculty and staff initially. The staff was trained on the system and designated individuals are in place as backups to use the system. Initial messages were vague and basically the college was put in lock down until more information was attained. Additional messages were put out after more information from the incident was received detailing specific actions for the students and staff. Review the plans in place and revise as needed for alerting 9 Page

10 procedures. Continue to train the students and staff on the system. Task # 1.3: Access and activate citizen notification system then send appropriate message to identified affected and / or at-risk population. Recommendations The staff was trained on the system and designated individuals are in place as backups to use the system. The messages were crafted by committee and were approved by the appropriate individuals. Continue training for those that need it. I am not sure if they have pre scripted messages but if not would be worthy of putting some in place. HazMat Response and Decontamination Performance Needs Improvement Core Capability Activity # 1: Site Management and Control Associated Critical Tasks Task # 1.1: Conduct initial approach and positioning of responders. Response units were located in the Warm and Hot Zone. Recommendations Gather more information while in route if suspected Haz-Mat incident. Task # 1.2: Implement / integrate HazMat resources into the ICS organization. Strong Evaluator # 1 Haz-Mat representative was added to Unified Command. 10 Page

11 Task # 1.3: Establish and identify visually an isolation perimeter (outer perimeter) to isolate the area and deny entry. Needs Improvement Evaluator # 1 No perimeters were set in the beginning. Recommendations If the response is a suspected Haz-Mat incident establish Hot, Warm and Cold Zones. Task # 1.4: Establish a hot zone (inner perimeter) to identify high hazard area(s) where responders will operate. Needs Improvement Evaluator # 1 No Hot Zone was established. Establish a Hot Zone right away. Task # 1.5: Establish other hazard control zones, based upon scope and nature of the event. Needs Improvement Evaluator # 1 No zones were established. Set up needed zones accordingly based on the incident. Task # 1.6: Initiate initial public protective actions. Extinguished the fire and controlled the area. Set up zones earlier. Performance Adequate Activity # 2: Identify the Problem Core Capability Associated Critical Tasks 11 Page

12 Task # 2.1: Survey the incident scene. Needs Improvement Evaluator # 1 No 360 was done of the area. Recommendations Do a 360 of the building and gather more information of the area. Try to gather information from any victims that was involved in the incident. Task # 2.2: Conduct offensive or defensive reconnaissance operations, as necessary, to gather intelligence on the situation. Offensive recon was done by attack crew. Defensive recon was done towards the end by the Haz-Mat team. Performance Adequate Core Capability Activity # 3: Select Personal Protective Clothing and Equipment Associated Critical Tasks Task # 3.1: Selection of respiratory protection. Strong Evaluator # 1 Attack crews wore SCBAs for entry. Task # 3.2: Selection of skin protection. Attack team wore bunker gear upon entry not knowing what the chemicals were. Gather more information upon arrival to ensure proper PPE. 12 Page

13 Task # 3.3: Use of chemical protective clothing garments considers impact of heat stress upon individual responders and overall response operations. Proper PPE was used for decon and recon. Task # 3.4: Discussion of safety issues and emergency procedures. Strong Evaluator # 1 Command communicated well with all personnel. Recommendations Needed to put a person in the Operations Branch to assist with communication and operations. Performance Core Capability Adequate Activity # 4: Implement Response Objectives Associated Critical Tasks Task # 4.1: Determine the nature and priority of rescue operations and the numbers involved. Lack of control of contaminated personnel. Contain any and all contaminated people in a certain area. Task # 4.2: Implement safe and effective tactics to accomplish rescue operation objectives. All personnel were in proper PPE and preformed safe actions. Task # 4.3: Identify personnel and equipment requirements to initiate 13 Page

14 product/agent control operations. Strong Evaluator # 1 All PPE and safety equipment was in place Task # 4.4: Implement safe and effective tactics to accomplish product / agent control objectives. Strong Evaluator # 1 All actions were performed in a safe manner with correct PPE and Haz-Mat equipment. On-Site Incident Management Performance Needs Improvement Core Capability Activity # 1: Establish and Maintain Full On-Site Incident Command Associated Critical Tasks Task # 1.1: Initiate and implement Incident Command System (ICS). Needs Improvement Recommendations Evaluator # 1 During the incident the Incident Command Post (ICP) was established without using any on scene assessment. The initial ICP was declared in the Hot Zone of the incident. There was nothing to identify who the Incident Commander (IC) was nor where the ICP was located. During the exercise the ICP kept moving with the IC as he walked around. I would recommend that the whole process should have been slower, using an on scene assessment and all available data, and then establishing the ICP. The ICP should have been identified by a green flag or green light as per ICS. 14 Page

15 Again I would recommend that documentation be used, additional personnel to help the IC run the incident. Additional training needs to be done on ICS and get buy in from those who use it. Adequate Evaluator # 2 Fire established IC immediately and then upon arrival of other agencies a Unified Command was established early. Strong Evaluator # 3 First arriving fire unit on scene established Incident Command. Task # 1.2: Transfer command, as appropriate. Incident Command was initiated by Fire and was not relinquished during the exercise. Recommendations Needs Improvement If the exercise would have ran longer I believe that Incident Command would have been transferred to Law Enforcement for crime scene investigations. Evaluator # 2 Campus security s initial responder did not meet with next deputies to transfer command or information. Adequate Evaluator # 3 No transfer of command was needed. Task # 1.3: Establish the command structure to manage the incident and meet objectives. Needs Evaluator # 1 15 Page

16 Improvement The only command structure that I observed was an IC. No other positions were filled as far as I know. They did set up a Unified Command. Recommendations Establish some positions to relieve some of the weight from the IC, I did not observe a Safety Officer, should have been used for this incident. A resource person, very much needed for tracking and accountability. Operations Chief would have been helpful for tactics on the incident. I know sometimes in the heat of the moment, time isn't taken to do these things but if they would have been done it would have ran smoother. Adequate Evaluator # 2 All UC worked well together with open communication. Only UC Commanders communicated with responding units. Adequate Evaluator # 3 Only IC was established. Add other positions as needed. Task # 1.4: Establish processes to order, track, assign and release incident resources. Needs Improvement Recommendations Needs Improvement Evaluator # 1 As far as I could tell there was no one tracking any resources for the incident, no personnel accountability procedures were seen. IC should designate someone for resource accountability. There are many systems available to track resources during an incident, from complex and expensive to as something as simple as a pad of paper for logging resources, equipment, personnel, time, etc. Evaluator # 2 16 Page

17 Recommendations Needs Improvement There was no identifiable delineation of Logistics, Operations, Planning, Safety, etc. The incident was fluid and response was without many critical issues. Having a person to track resources would aid in safety and resource documentation. Evaluator # 3 Performance Adequate Core Capability Activity # 2: Develop Incident Action Plan (IAP) Associated Critical Tasks Task # 2.1: Establish incident objectives, priorities, and operational periods. Needs Improvement Evaluator # 1 I did not see or hear an IAP. Recommendations The IC did not write anything down during the exercise. I would recommend that at a minimum some sort of notebook or log to document actions, or bullet points to establish items that need to be done. This could be used as an IAP to some degree. I believe if a proper ICP would have been established and not a roving ICP more could have been organized and documented. Adequate Evaluator # 2 Tracking of resources was done on the fly with full knowledge of those in the UC. No resource tracking was observed. Not aware of any staging area that was established. Resources were released and return to service when no longer needed. It appears that all responders were adequately and appropriately trained. 17 Page

18 Adequate Evaluator # 3 A verbal IAP was communicated with others at the CP Prepare written IAPs. Public Safety and Security Response Performance Adequate Core Capability Activity # 1: Activate Public Safety and Security Response Associated Critical Tasks Task # 1.1: Conduct a public safety and security response. Needs Improvement Evaluator # 1 The campus security responded to the scene and when he approached victims he did not question as to the cause of their injuries and evaluator is not aware if he communicated the location of victims. When deputies arrived their initial question was what happened, and he was told an explosion. He did not question further as to possible hazards and entered the building after hearing calls for help. Therefore, he became exposed to the hazardous environment and would have been injured if hazardous was real world. The second deputy arrived and also entered the building becoming exposed. Deputy did discuss and take into consideration about wind direction. Recommendations First responders must make efforts to gather as much information as possible in route and upon arrival to ensure their safety and those responding behind. Task # 1.2: Establish or integrate into Incident Command / Unified Command (IC / UC). 18 Page

19 The deputies apparently did not transfer IC and evaluator is unsure if their findings were given to dispatch or others. An IC was established and quickly became Unified Command. Recognized possibility IC was within wind direction and was moved. Deputies moved victims up wind. Task # 1.3: Ensure that responders have the appropriate equipment to perform assigned tasks. Deputies have no PPE to investigate any hazardous incident. First firefighter on scene utilized SCBA, however applied ventilation and possibly spread hazardous exposure outside building. Performance Adequate Core Capability Activity # 2: Command and Control Public Safety and Security Response Operations Associated Critical Tasks Task # 2.1: Identify personnel needed to maintain security support and response. Relocated Triage and set up decon. Recommendations Establish stronger security check points with identification of those individuals entering the crime scene. Task # 2.2: Deploy appropriate personnel. The whole operation had an excellent response and involvement from all public safety agencies in Columbia County. 19 Page

20 Task # 2.3: Coordinate with IC / UC. Witnessed several conversations and meetings between UC. Worked well together. Performance Adequate Core Capability Activity # 3: Control Traffic, Crowd and Scene Associated Critical Tasks Task # 3.1: Identify and establish an incident perimeter and zones. Law Enforcement had initial campus roads blocked but expanded perimeter after recognizing need soon afterwards. IC established 500' perimeter, but evaluator unsure if this was communicated to all responders. Task # 3.2: Identify security zone requirements. Law Enforcement became aware that this was a crime scene and issued BOLO for suspects. However, the scene was not initially secured with control or identification of those on scene. Task # 3.3: Establish force protection capacity integrated within Incident Command System (ICS). 20 Page

21 A lot of people standing around IC, but typical in an exercise setting. Task # 3.4: Provide force protection for emergency response personnel to allow them to operate safely. Law Enforcement maintained safety. Task # 3.5: Implement and maintain an on-scene personnel identity management system. Needs Improvement Evaluator # 1 Law Enforcement became aware that this was a crime scene and issued BOLO for suspects. However, the scene was not initially secured with control or identification of those on scene. Task # 3.6: Control traffic and crowds. One campus employee was detained as contaminated, but only after several walks into the scene. 21 Page

22 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 Core Capabilities and Tasks evaluated during the exercise. This summary outlines the areas in which exercise participants are strong as well as identifying areas that the departments should invest future planning, training and exercise funds on. Citizen Notification Activity Core Capability Performance # 1 Notification Implementation Adequate HazMat Response and Decontamination Activity Core Capability Performance # 1 Site Management and Control Needs Improvement # 2 Identify the Problem Adequate # 3 Select Personal Protective Clothing and Equipment Adequate 22 Page

23 # 4 Implement Response Objectives Adequate On-Site Incident Management Activity Core Capability Performance # 1 Establish and Maintain Full On-Site Incident Command Needs Improvement # 2 Develop Incident Action Plan (IAP) Adequate Public Safety and Security Response Activity Core Capability Performance # 1 Activate Public Safety and Security Response Adequate # 2 Command and Control Public Safety and Security Response Operations Adequate # 3 Control Traffic, Crowd and Scene Adequate 23 Page

24 APPENDIX A: IMPROVEMENT PLAN This Improvement Plan has been developed specifically for the Columbia County Emergency Management Department based on the results of Columbia Chemical Calamity - A HazMat Response Full-Scale Exercise conducted on February 20, These recommendations draw on both the After Action Report and the After Action Conference. Capability Observation Recommendation Responsible Agency Completion Date Florida Gateway College has recently implemented several mass notification systems. In addition to college students, instructors and staff ensure the following entities are added to the mass notification systems: Citizen Notification County Emergency Management County / City Fire Departments County / City Elected Officials County Health Department County Sheriff s Office City Police Department 911 / Dispatch Center Hospitals Neighbor Businesses / Residences Florida Gateway College 7/1/ Page

25 Florida Gateway College has a working draft of a Campus Notification Plan. Upon finalizing the plan conduct a workshop for college staff and appropriate community partners on how and when the plan will be activated. Florida Gateway College 9/1/2015 Citizen Notification Columbia County currently does not have a mass notification system. Participate in Alerting Anxiety A Campus Notification Exercise on an ongoing basis. Information on this free internet based exercise can be found at: Research the viability of using a simple opt-in system such as Nixel and / or IPAWS as a countywide notification system. Florida Gateway College Columbia County Emergency Management On-Going 8/1/2015 Many agencies, organizations and Florida Gateway College have their own Public Information Officers (PIO) however their efforts are not effectively coordinated. Convene a meeting of all public and private sector PIOs in Columbia County to discuss establishing a Joint Information System (JIS). Columbia County Emergency Management Florida Gateway College 6/1/ Page

26 HazMat Response and Decontamination During the initial response Hot, Warm and Cold Zones were not extablished. Initial response personnel failed to size-up the scene and gather additional information. There was a lack of control of contaminated victims and response personnel. Conduct a minimum of two Hazardous Materials Refresher Workshops for non-fire response personnel. Columbia County Emergency Management North Central Florida Local Emergency Planning Committee 10/1/2015 The Incident Command Post (ICP) was not identified. Purchase ICP identification kits and distribute to appropriate response agencies. Columbia County Emergency Management 7/1/2015 On-Site Incident Management While an Incident Command Post was established there was a lack of any identifiable operations structure. Conduct an ICP tabletop exercise with several scenario vignettes. The focus of the exercise will be to enhance ICP knowledge and assess current capabilities. Columbia County Emergency Management 10/1/2015 Public Safety and Security Response During the exercise there were several radio communications challenges experienced by various response agencies. The majority of these challenges were technical in nature. Columbia County is currently in the process of conducting a technical review / evaluation of its combined communications network. Upon completion of the review / evaluation prepare an action plan designed to enhance communications among first responders and the combined communications center. Columbia County Emergency Management Within 12 months of completing the review / evaluation 26 Page

27 APPENDIX B: PARTICIPANT FEEDBACK (Strengths Areas for Improvement) Strengths Thought the college's communications were good. We had arranged for a place for media to meet for news releases. We were able to get messages out to our students via text, , social media and the college's website and television station. Were also able to send messages to campus digital signage and to all PX units on campus. Locating scene and perimeter set up. Teamwork of all agencies involved. Perimeter was established after notifying command staff. First two deputies were able to assess the damage and injuries of students. Teamwork with all agencies and departments. I thought it was very well planned. The agencies worked well together. I felt like all of the assisting agencies worked well together and that each one knew their role. I felt like law enforcement did a good job locating the information in reference to what chemicals were used in the explosion which was then relayed to the fire department. I felt like the fire department did a good job responding and getting their Haz-Mat Team in quickly to secure the scene. Communication between agencies. Collaboration between agencies. Agencies understood and performed their assigned roles in this exercise. Agencies worked well together, all knew each other. Haz-Mat Team was very well trained. Haz-Mat Team set up in a proper location. All agencies worked well together. 27 Page

28 Unified Command was implemented early in the scenario. The incident was mitigated in a timely manner. Law Enforcement blocked off streets. Set up decon line and moved people through. No one was hurt. I feel that we as Sheriff s Office did a good job responding to the 911 call. Setting up the Command Post. Clearing the scene. Large number of participants from a variety of agencies. Plausible exercise scenario. Fast setup of decon line. Realistic. Great responder turn out and participation from the college. Responders took the exercise as real. Incident Command was well established. Good cooperation between disciplines. All public safety agencies involved worked well together and coordinated response with Florida Gateway College personnel. Perimeter was quickly established. Equipment was in good working order. I feel like we worked well together as a team amongst our own agency. I believe we worked well with all agencies involved and there was never disagreements of who was going to be more "in charge." I believe that it provoked a lot of thinking and ideas towards a call like this, which is uncommon and not really thought on very often in day to day operations. Learned to be more aware and cautious of the injured and their relationship to the affected area as well as keeping them contained for decontamination before treatment. Was able to coordinate a perimeter and shift it as needed through communication within 28 Page

29 the Incident Command. Gained a great deal of knowledge watching how the infrastructure of critical incident relies heavily on good communication and team work with all departments. First of all, I want to say the whole exercise was well planned and I really appreciate all of the hard work that was put into this. All of the agencies worked well together once the determination was made of what resources were needed. The exercise provided the opportunity for agencies to think about what needed to be done if this had been a real situation. Lots of our local agencies were represented well. I was very pleased with the turnout from our local response personnel. Columbia County Fire Rescue establishing Incident Command as they arrived on-scene and as the event progressed transitioning to a Unified Command. Responders turned a negative into a positive. When it was realized that the scenario had a wind direction established it was treated as a change in wind at the Unified Command location. We received appropriate notifications with s that kept us informed. All agencies participated. The fire departments were helpful with their knowledge on Haz-Mat situations. Fire and EMS worked well together. Fire and EMS were able to use some of the equipment they normally don't. The way that agency response was staggered to make it realistic. Communications between Sheriff s Office and Dispatch. Well organized from sign up to closing reports. Number of agencies involved. Real world actions. I thought it was good learning experience for the Sheriff's Office to work with and understand the Fire Departments role in a chemical environment. A chemical environment is not an everyday event for the Sheriff's Office except for meth labs and we normally evacuate and call for officers with the special training to enter those environments. 29 Page

30 I always think any joint training that different agencies can do together has benefit's to show the difficulties of communication, the understanding of the leadership roles in a Command Post, and the different training and equipment that different agencies possess. With all that said, I believe the training went well to the point off everyone understanding the different roles that each agency will undertake in a chemical environment. Communication between the Command Post and college staff was good. Helped the college understand ways that our response should be changed for improvement. Drill was well planned and executed. Good response time. Entry and assessment teams appeared to respond in a safe and timely manner. Decon appeared to function very well. Haz-Mat Team ready and able to decon quickly. Patients were triaged quickly. Good communication between college and Incident Command. I felt the exercise was well run, organized and managed. All responders appeared to work well together. Fire had sufficient manpower and equipment to handle such a hazardous event. All parties involved communicated well. Had enough resources on hand to get the task completed. If something occurred that was not expected, we utilized what was on hand to get the task completed. All the different agencies that were present worked well together to accomplish the different tasks. Decon set up by the Lake City Fire Department was really good and was very efficient in containing the hazardous material at the designated area. I think it s always good to perform these types of scenarios so we will be better prepared to handle situations like this that can occur almost any day. Both Fire agencies worked well together. 30 Page

31 EMS worked well with Fire. Command structure was established quickly and everyone worked together seamlessly across all disciplines. Hazards and threats were identified continuously throughout the event and mitigated quickly. Communication between city and county agencies. Fire s extraction of students from building. Haz-Mat Team setup and operation. All agencies worked well together. The Haz-Mat Team decontamination procedures. The college personnel did a great job. On scene crew did a good job. Haz-Mat Team had a good response and set up. Excellent participation by all agencies / organizations and all worked well together. Florida Gateway College personnel reacted to the incident according to plan and expectations. Good job of establishing perimeter and locating suspects. Good job of providing support including notification and ability to bring in resources. Availability of resources and ability to request and obtain resources was a positive. Initial staging of resources and flow of resources to incident scene went well. Incident Command was established early on by Fire and transition to Unified Command was also implemented in timely manner. Good communications between Incident Command Post and college. Good coordination and communication between college and responders. Good job of moving patients out quickly. Good job of setting up, running, and demobilizing decon operations. Areas for Improvement Most of what happened did so on the fly. We need our plans documented. 31 Page

32 Need to have someone available to speak to parents of victims. Once the event started we had no one to monitor classrooms on campus to make sure people were indoors. Radio communications were poor. Difficult to understand some communications. Larger perimeter. Better communication between departments and agencies. The Staging Area and the Command Post should have been farther away from the Hot Zone. EMS shouldn't have agreed to enter the Hot Zone and become contaminated. Should have had more EMS units. I felt like the communication system created issues. Once anyone went inside of the building it was nearly impossible for them to get their radio transmission out. As far as Law Enforcement goes I believe that we could have slowed our response a little more instead of rushing into an unknown chemical explosion. Law Enforcement could have set up a larger perimeter. Clearly display Hot Zone areas. Incident Command system needs to be used properly. Training needs to be done with response personnel and safety and scene size up. Two Law Enforcement officers entered the building causing themselves to be victims. Scene size up and not rushing to establish a command. Communications as a whole. The Haz-Mat Team could have been more involved. There were a number of vehicles and personnel too close to the incident. Until Incident Command knows what we are dealing with, it is imprudent and reckless not to have buffer zones. Incident Command should also have been farther back. There was no physical Command Post. The Incident Commander would walk away and then people would follow. People were trying to read papers that kept falling on the ground and getting blown around. Just a pop up or attachable sign with "Incident Command" and the back of an SUV or truck would suffice. Could have marked off the Hot Zone, and the decon area better. Also, people walked and drove through the Hot Zone. Entry teams should have relied more on ph paper, the 32 Page

33 meters would have been ruined potentially in this scenario. Better ID of the safety guys. Need to better identify Incident Command Post (ICP). Also felt that ICP was too close to the scene. Incident Command needs better organization. Appeared as if one person was trying to do it all. With the number of assets available Incident Commander should delegate some responsibility. For example assigning someone to check in assets as they arrive. Assignment of a Haz-Mat Specialist to the ICP. Heard mention of the chemicals involved but no discussion on what the byproducts of the mixtures were and exactly what testing was being performed to ensure the lab was safe for reentry. Security was good. But, we did have at least one individual wander into the Hot Zone. Since the campus has an active lab on site, it would be good for them to have a primary and secondary contractor designated who could respond for cleanup. Clearly identify the Unified Command location. Delineate barriers better. The County PSAP was never tested for the volume of calls they would have received. No attempted to overload PSAP and see how quickly backups come on-line and operate. The Command Post was set up too close to the Hot Zone, while this was only a drill people tend to fall back on their training during times of stress. This could prove to be a problem with Command Post location if drills continue to do this. Our radio system needs improving. Situational Awareness needed improving. Having a way that all agencies involved can hear what is going on between the other agencies and therefore eliminate some of the guessing of what is going on. Better placement of the staging area in relationship to the scene. It was entirely too close to be able to take away some of the artificiality. Information was not relayed by Incident Command of possible number of victims which delayed responses for additional personnel needed. First crew arrived on scene to multiple victims but only one EMS unit had been dispatched. No Hot Zone had been set up therefore EMS crews entered the Hot Zone becoming contaminated and were limited in what they could do at that point. Communications from the Incident Command / Unified Command were not as fluid as they could have been. I'm not sure if it was a hardware item or a larger issue with the radio system itself. 33 Page

34 Identification of the Incident / Unified Command location. Communications are always lacking in exercises such as this. Even in real life communications are lacking More face to face communications upon start up or just prior to the startup of the exercise The staging area could have been set a little farther back to make it slightly more realistic. However, I understand some logistic issues this might cause. A base station for dispatch instead of portables. We needed training in a chemical environment, the first responding officers could have used a little more caution when they figured out they had a chemical environment. I know it s hard to get enough space to create an event, but I would have liked to see everything in a more realistic separation, chemical scene, Command Post, triage, Decontamination Area. College staff should have some way to communicate with the Incident Command or hear radio conversation. Radios seem to be a problem for agencies to communicate. Perimeter seems to not be secured. College employee walked into Hot Zone easily. Clearly identify Incident Command location to all responders. Clearly identify Hot, Warm and Cold zones. Enhance perimeter security to restrict access by general public. No clear lines of Hot and Cold Zones. Never asked or told to stay out of Hot Zone. Walked past several firefighters and no one asked me to stop. When we asked for additional resources we were not informed if they were in route. Law Enforcement should remember that this was a crime scene and while they must wait for Fire to clear the scene, they may face chain of custody issues later. Fire vented the hazardous area potentially exposing others. Law Enforcement should make more detailed inquiries before entering the Hot Zone. Check all equipment, the day before going in the field. Needing to invest in some type of portable protection for all weather types. 34 Page

35 Communication between agencies and equipment limitations needs to be addressed. Maybe next time have the Command Post further away from the incident so they can let the others be more of their eyes on scene and will be able to make decisions based on information relayed back to them instead of watching with their own eyes. Staging Area way to close to actual scene. Communication system didn't work well. Communications. Placement of the Command Post. Radio communication between college and agencies. Perimeter identification. Zone identification. Communication between agencies and dispatch. Communications. More training like this. Although patients were moved out quickly, better Situational Awareness should be exercised by Fire to determine cause of incident. Communications issues: Responders not always utilizing primary channels. All players need to be on same page. Example: EMS was not always effectively communicating regarding contaminated patients which caused some contaminated patients to bypass decon early on and go straight to triage. Tracking of resources was lacking due to communications issues with Unified Command. The Command Post should have been more clearly identified with signage or other indicator. EMS did not always provide update on patients to school personnel. The Command Post could have been physically located farther from the incident scene. Some confusion with location of Cold, Warm and Hot Zones. Staging Area to close to incident scene. 35 Page

36 APPENDIX C: ACRONYMS Acronym Meaning COMM CONOPS EOC ESF IAP IC ICP ICS IMT JIC LOFR MOA MOU NIMS OPS PIO PPE SCBA SitRep SOG SOP UC Communications Concept of Operations Emergency Operations Center Emergency Support Function Incident Action Plan Incident Command Incident Command Post Incident Command System Incident Management Team Joint Information Center Liaison Officer Memorandum of Agreement Memorandum of Understanding National Incident Management System Operations Public Information Officer Personal Protection Equipment Self-Contained Breathing Apparatus Situation Report Standard Operating Guideline Standard Operating Procedure Unified Command 36 Page

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