RHODE ISLAND LONG TERM CARE MUTUAL AID PLAN FUNCTIONAL EXERCISE

Transcription

1 RHODE ISLAND LONG TERM CARE MUTUAL AID LAN FUNCTIONAL EXERCISE Northern Region - September 11, 2013 Southern Region - September 13, 2013 After Action Report/Improvement lan October 28, 2013 Report repared By: The After-Action Report/ aligns exercise objectives with preparedness doctrine to include the National reparedness Goal and related frameworks and guidance. Exercise information required for preparedness reporting and trend analysis is included; users are encouraged to add additional sections as needed to support their own organizational needs. Rev. April 2013 HSEE-I01

2 CONTENTS Exercise Overview...3 Analysis of Core Capabilities...6 Appendix A: Improvement lan (I) Appendix B: Emergency Reporting System (Detailed Reporting) B1a Northern Region LTC Tracking Board B1b Northern Region Expanded Summary Report (by city) B1c Northern Region Staff Report (by city) B2a Southern Region LTC Tracking Board B2b Southern Region Expanded Summary Report (by city) B2c Southern Region Staff Report (by city) Appendix C: ortable Disaster Cart / Kit (photos and contents) Appendix D: Command Center Layout Appendix E: First 15 Minutes in the Command Center (Tool) Appendix F: ICS Training Resource Guidelines Appendix G: Facility Status Reports G1 Northern Region G2 Southern Region Appendix H: Online Questionnaire Responses Table of Contents 2 Rhode Island Department of Health

3 EXERCISE OVERVIEW Exercise Name Exercise Dates Scope RHODE ISLAND LONG TERM CARE MUTUAL AID LAN (LTC-MA) FUNCTIONAL EXERCISE Northern Region September 11, 2013 (September 10 for reporting) Southern Region September 13, 2013 (September 12 for reporting) This exercise was a, covering advance reporting for each exercise day (9/10 and 9/12) for three hours, two and a half hours (2-1/2) at Cedar Crest Nursing Centre and two and a half hours (2-1/2) at St. Elizabeth s Home. Exercise play (9/11 and 9/13) was limited to two and a half hours (2-1/2). Mission Area(s) Core Capabilities Objectives Response 1: Healthcare System (Community) reparedness: Community preparedness is the ability of communities to prepare for, withstand, and recover in both the short and long terms from public health incidents. 3: Emergency Operations Coordination: Emergency operations coordination is the ability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable system of oversight, organization, and supervision consistent with jurisdictional standards and practices and with the National Incident Management System. 6: Information Sharing: Information sharing is the ability to conduct multijurisdictional, multidisciplinary exchange of health-related information and situational awareness data among federal, state, local, territorial, and tribal levels of government, and the private sector. 10: Medical Surge: Medical surge is the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community 1. Activation: Upon the start of the exercise, utilize the activation/notification procedures within the LTC-MA. 2. Communication: Communicate appropriately between the Disaster Struck Facility, HEALTH, and each Resident Accepting Facility. 3. Emergency Reporting: Ensure that all facilities utilize the Emergency Reporting System at 4. atient Tracking: Ensure that residents are tracked throughout the entire process, from the Disaster Struck Facility (DSF) to the Resident Accepting Facility (RAF). Exercise Overview 3 Rhode Island Department of Health

4 Threat or Hazard Scenario Sponsor Hurricane The Narragansett Bay area is experiencing wide spread flooding near the shore line and low lying areas. There are reports of widespread power outages in the local area. Cedar Crest Nursing Centre in Cranston (9/11) / Saint Elizabeth Home in East Greenwich (9/13) have reported that they lost commercial power and then experienced a generator fire that destroyed their electrical system capabilities. They need to evacuate their facility and request the assistance of the LTC-MA and its members. Rhode Island Department of Health (HEALTH) articipating Organizations State articipating Organizations Rhode Island Department of Health, Center for Emergency reparedness and Response Rhode Island Department of Health, Office of Facilities Regulation Local Fire, rivate EMS, and Emergency Management Agencies Cranston Fire Department Cranston Emergency Management Agency Med Tech Ambulance Northern Region Disaster Struck Facility Cedar Crest Nursing Centre, Inc. 156 Bed 53 other member LTC-MA facilities Southern Region Disaster Struck Facility Saint Elizabeth Home 120 Bed 35 other LTC-MA facilities Other Exercise articipants Hospital Association of Rhode Island Leading Age of Rhode Island Rhode Island Health Care Association Rhode Island Long Term Care Ombudsman roject Consultants Russell hillips & Associates, LLC Exercise Overview 4 Rhode Island Department of Health

5 Rhode Island Department of Health OC: oints of Contact Alysia Mihalakos, MH Interim Chief, Center for Emergency reparedness & Response (CER) Rhode Island Department of Health 3 Capitol Hill, Room 402 rovidence, Rhode Island (office) Alysia.Mihalakos@health.ri.gov Russell hillips & Associates, LLC OC (Exercise Support): Scott Aronson rincipal Russell hillips & Associates, LLC x (corporate) saronson@phillipsllc.com Acronyms DSF HARI HEALTH HEALTH/LTC Group HEALTH DOC LTC-MA RAF Disaster Struck Facility Hospital Association of Rhode Island Rhode Island Department of Health Rhode Island Department of Health & Long Term Care Group Rhode Island Department of Health Operations Center Long Term Care Mutual Aid lan Resident Accepting Facility Exercise Overview 5 Rhode Island Department of Health

6 ANALYSIS OF CORE CAABILITIES Aligning exercise objectives and core capabilities provides a consistent taxonomy for evaluation that transcends individual exercises to support preparedness reporting and trend analysis. Table 1 includes the exercise objectives, aligned core capabilities, and performance ratings for each core capability as observed during the exercise and determined by the evaluation team. Capability Objective Capability Objective 1: Activation: DSF Capability Objective 2: Communications Associated Critical Task (Simulate) Call 911 or the local ublic Safety Answering oint (SA non-emergency y phone number ) Implement internal disaster notification, and activate Disaster Struck Facility Command Center Notify HEALTH Duty Officer (CER) to activate the LTC-MA (N and/or S Region) and Critical artners through the alert notification system Activate Emergency Reporting at Notify HEALTH for the reportable incident Assign a Liaison Officer to communicate with EMS/Fire re: resident placement and transportation needs Assign a Liaison Officer to communicate with the designated EOC/HEALTH location for coordination of supplies, equipment, etc. Advised the HEALTH LTC Group as to the number of residents and type of residents to place and the transportation the residents required erformed without Challenges () erformed with Some Challenges (S) S erformed with Major Challenges (M) Unable to be erformed (U) Analysis of Core Capabilities 6 Rhode Island Department of Health

7 Capability Objective Capability Objective 2: Communications (cont.) Capability Objective 3: Evacuation Capability Objective 4: atient Tracking Associated Critical Task Effectively communicate and update tracking and resident information with the Resident Accepting Facilities and the HEALTH LTC Group Establish Incident Action lan (IA), coordinate IA with HEALTH, local responders and local Emergency Management Agency Command Staff receives the status reports from each department and aggregate data for the number and type of transportation needed for residents necessary to evacuate the facility Census Reduction discussed in the Command Center as a viable option for some residents, vs. evacuation Emergency Reporting in the LTC-MA website, accessed for receiving updates From the status reports, Command Staff identified current and future needs (supplies/equipment, transportation, staffing) Command Staff mandates use of the Resident / Medical Record / Staff / Equip Tracking Sheet Command Staff direct staff to utilize Resident Emergency Evacuation Forms Residents tracked and accounted for with RAF/HEALTH LTC Group erformed without Challenges () erformed with Some Challenges (S) S S S S erformed with Major Challenges (M) Unable to be erformed (U) Analysis of Core Capabilities 7 Rhode Island Department of Health

8 Capability Objective Capability Objective 5: lanning: HEALTH LTC Group Associated Critical Task Ensure 100% of facilities utilize the Emergency Reporting System at Ensure HEALTH LTC Group s ability to aggregate data from the LTC-MA members to support open beds, operational issues, resources & assets needs, and staffing resources, and provide aggregate reports for Steering Committee Members and partners as requested Did the HEALTH LTC Group work on alternate strategies for placement of special care residents (dementia secured units) or look at larger groupings of beds for placement erformed without Challenges () (9/13) (9/13) erformed with Some Challenges (S) S (9/11) S S (9/11) erformed with Major Challenges (M) Unable to be erformed (U) Ratings Definitions: erformed without Challenges (): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. erformance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. erformed with Some Challenges (S): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. erformance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. However, opportunities to enhance effectiveness and/or efficiency were identified. erformed with Major Challenges (M): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s), but some or all of the following were observed: demonstrated performance had a negative impact on the performance of other activities; contributed to additional health and/or safety risks for the public or for emergency workers; and/or was not conducted in accordance with applicable plans, policies, procedures, regulations, and laws. Unable to be erformed (U): The targets and critical tasks associated with the core capability were not performed in a manner that achieved the objective(s). Table 1. Summary of Core Capability erformance Analysis of Core Capabilities 8 Rhode Island Department of Health

9 The following sections provide an overview of the performance related to each exercise objective and associated core capability, highlighting strengths and areas for improvement The strengths and areas for improvement for each core capability aligned to this objective are described in this section. Capabilities Objectives: Activation Strengths The capability level can be attributed to the following strengths: Strength 1: Activation Systems. The two activation systems for the LTC-MA are the Rhode Island (RI) HEALTH Notification System and the LTC-MA website. Both of these notification systems performed well. Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Key Contacts. Not all plan members have entered leadership personnel as facility contacts in the LTC-MA website. This prevented them from receiving the LTC-MA activation and the RI HEALTH Notification System alert. Reference: Hotwash Conference Call, DSF Holding Area Controller, LTC-MA website. Analysis: Contacts not entered into the LTC-MA system. Area for Improvement 2: Improper LTC-MA Activation. Activation of the LTC-MA Emergency Reporting System experienced a few challenges. There were several occasions, during the May and the September exercises, where an LTC-MA member erroneously activated the Emergency Reporting System when trying to complete emergency reporting. One of these occasions occurred during the first day of exercise play. Reference: Russell hillips & Associates Analysis: Training on activation of the LTC-MA Emergency Reporting System internally at facilities. Area for Improvement 3: Contact Updates RI HEALTH Notification System. The updates for the RI HEALTH Notification System were cumbersome. Thirty-six (36) individuals had to be manually reviewed and entered due to irregularities for a clean cross-reference between the LTC-MA system report and the fields customized by RI in the RI HEALTH Notification System. Reference: Hospital Association of Rhode Island (HARI) Analysis: Incorrect matching of field names between the LTC-MA system and Everbridge. Analysis of Core Capabilities 9 Rhode Island Department of Health

10 Activation (continued) Area for Improvement 4: LTC-MA System Error. Upon activation, on Day 1 of the exercise, the LTC-MA system page showed an error when you accessed the landing page. This was the only site experiencing a technical error and the only page within the RI LTC-MA site experiencing an error. Due to this being a landing page, the error was not generating an alert to the System Administrator. Reference: HARI, HEALTH and LTC-MA Members Analysis: Scripting error that did not send an immediate internal error report to LTC-MA System Administrator. Area for Improvement 5: Everbridge Recorder. Upon activation on Day 1, the Everbridge system would not allow access to the Everbridge Recorder. HARI addressed this through a telephone call-in feature and the feature worked fine. Reference: HARI Analysis: N/A Communications Strengths The capability level can be attributed to the following strengths: Strength 1: Overall Communication. The overall communication between the DSF, RAFs and the HEALTH LTC Group was very good. The DSFs developed an Incident Action lan (IA). Within the IA, a Liaison Officer was established. This provided a coordinated approach with the DSF community partners and with the HEALTH LTC Group. Strength 2: Notifications. Notifications via the Rhode Island HEALTH Notification System were excellent. There were no complaints that the message was not received on any of the devices that members entered into system. Strength 3: DSF and HEALTH Incident Commanders (ICs). The communications specifically with HEALTH LTC Group and the DSF were good for the Northern Region exercise and more efficient with the Southern Region exercise as regular briefing times were established between the ICs. Strength 4: Regional Conference Call. The HEALTH LTC Group initiated a Regional Conference Call for providing an update to all LTC-MA members in the region. During this call, a briefing was provided detailing the infrastructure failure at the DSF and what assistance they were requesting from the HEALTH LTC Group and the Resident Accepting Facilities (RAFs). The HEALTH LTC Group provided an update on the number of facilities that completed their Emergency Reporting, the number reporting operational issues (brief summary) and the available beds in the region. Analysis of Core Capabilities 10 Rhode Island Department of Health

11 Communications (continued) Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Alert Messages Voice Speed. The messages via the RI HEALTH Notification System, using the automated voice, are too rapid and people had difficulty taking down the key information (e.g., phone number for the Conference Call). Reference: HEALTH LTC Group Controller, Hotwash Conference Call Analysis: N/A Area for Improvement 2: Communications Devices HEALTH LTC Group. Shortfalls exist with the communications devices in HEALTH s Department Operations Center (DOC): 1. hones hones in the DOC do not rollover and often rang unanswered due to the HEALTH LTC Group staff being on the same phone. 2. Fax The HEALTH LTC Group had to be informed when faxes were being sent and then a runner was sent to the CER office. A runner did periodically check the fax, but prompting was the primary mechanism to ensure the group understood a fax had been sent. Reference: DSF Command Center, Hotwash Conference Call, HEALTH LTC Group Controller Analysis: The phone calls were not being answered when others were on the line and HEALTH LTC Group was unable to determine when a fax was received, as the fax machine is not located in the DOC. Area for Improvement 3: Communications Devices DSF Command Centers. Shortfalls in the DSF Command Centers: 1. hones: There was only one phone in the Command Center at each DSF. It was a challenge for staff in the Command Center to manage the incoming calls. All outgoing calls took place via cell phones, enabling the phone in the room to be available for incoming calls. Both DSF s lacked the capability of direct dial phone communications out of the Holding Area (final point of triage and discharge from the DSF). 2. Fax: The DSF Command Center staff needed to be informed when faxes were being sent and then a runner was sent down the hall. A runner did periodically check the fax, but prompting was the primary mechanism to ensure the group understood a fax had been sent. Reference: DSF Controller Analysis: All outgoing calls needed to be made by cell phones and the group was unable to determine when a fax was received, as the fax is not located in the Command Center. Analysis of Core Capabilities 11 Rhode Island Department of Health

12 Communications (continued) Area for Improvement 4: Non-reporting Facilities on the Emergency Reporting System. The HEALTH LTC Group communicated with facilities that did not complete their Emergency Reporting. They experienced challenges with people being unaware an exercise was taking place, people stating they would complete their Emergency Reporting (then not doing so) and people that were unsure how to login to complete their Emergency Reporting. Reference: LTC-MA Algorithm 1.1 and 1.2 for actions, HEALTH LTC Group Controller Analysis: Internal Training on responding to the Emergency Reporting System request and handling of calls from the HEALTH LTC Group. Area for Improvement 5: Inject Responses. There were multiple injects where the facilities received calls from the media and families. On many occasions, the person who answered did not know how to process the calls. Reference: Hotwash Conference Call Analysis: Internal training on handling media and family calls. Lack of a ublic Information Officer position being activated. Evacuation Strengths The capability level can be attributed to the following strengths: Strength 1: DSF Holding Area. The staff in the holding area were responsible for organizing mock resident discharge paperwork, medications, personal belongings, utilizing the LTC-MA resident tacking forms, working in conjunction with HEALTH with their atient Tracking System and notifying the RAF s that the residents were en route to their facility. This proved at times to be stressful, but was very successful. Strength 2: Clinical Support Teams. Each DSF established clinical support teams to receive calls from the RAF s dealing specifically with clinical issues. Clinical support teams were also identified to deploy to the RAF s and support continuity of resident care. Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: LTC-MA forms. All LTC-MA members need to become fluent with the LTC-MA forms. The primary forms for this include the Resident Emergency Evacuation Form (one per resident), the Resident/Medical Record/Staff/Equipment Tracking sheet (run sheet of residents going to a specific facility and their transportation vehicles they are traveling in) and the Influx of Residents Log (completed at the RAF to cross-reference everyone that was received). It was noted by users that a ballpoint pen should be used and to press hard when filling out the forms for all copies to be legible (writing on a clipboard or solid surface). Analysis of Core Capabilities 12 Rhode Island Department of Health

13 Evacuation (continued) Reference: Hotwash Conference Call, RAF Exercise Evaluation Online Results Analysis: Many forms were not filled out completely and ages 2 & 3 (of the 3 part NCR forms) were often illegible. Area for Improvement 2: Holding Area Location, Staffing, Equipment and Supplies. LTC- MA members need to identify a suitable Holding Area within their facility, the process for managing this area and resources/assets necessary to operationalize the location. Staffing: Staffing levels in the Holding Area were inadequate. Specifically, Cedar Crest had a large number of mock residents and needed to reallocate staffing from other areas to support the area. Medical Equipment and Supplies: There were discussions that took place to identify the medical equipment and supplies needed to support the Holding Area. Reference: Hotwash Conference Call, DSF Holding Area Controllers, discussions with mock residents Analysis: Operationalizing the Holding Area will require additional planning; consider the following: Identify an open space where the DSF can document that residents have arrived, triage residents and provide care or activities as necessary (medication, vitals, etc.). Document residents as they leave the building, ensure direct communication lines with the facility Command Center and have a phone line for direct communications with the RAF s if the Holding Area is designated as the group making direct calls to the RAF s. atient Tracking Strengths The capability level can be attributed to the following strengths: Strength 1: atient Tracking System. The RI electronic atient Tracking System (TS) and the paper patient tracking system (a component of the LTC-MA), worked well. 100% accountability of all patient movement was obtained from both systems. Strength 2: atient Tracking System rocess DSF. The TS was easily set up at the DSF. When the discharge process began they were able to keep up with the flow and all information transmitted with no failures. Analysis of Core Capabilities 13 Rhode Island Department of Health

14 atient Tracking (continued) Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Communicating Receipt of Received Residents. RAF s did not consistently contact HEALTH to confirm arrival of evacuated residents. There was substantial confusion on 9/11, as the phone number provided to the RAF s to contact HEALTH was transposed. This created a delay in the RAF s contacting HEALTH to inform them that they received their mock residents. This was rectified on 9/13, however, there were still many facilities that were not clear on the process when they receive mock residents. Reference: HEALTH LTC Group and DSF Controllers, Hotwash conference call Analysis: Facilities not utilizing the LTC-MA Influx of Residents Log and/or not calling HEALTH to close the loop on the arrival of evacuated / mock residents. Area for Improvement 2: Incomplete Documentation on Influx of Residents Log. Forms were received that lacked a full resident name, date of birth, or were illegible. This caused a challenge in verifying what residents were received by the specific RAF s. Reference: HEALTH LTC Group Controller Analysis: Facilities did not properly complete the Influx of Residents Log. Area for Improvement 3: Rhode Island atient Tracking System (TS). The challenges identified were the inability to sort by receiving facility. This is due to the system not having any LTC-MA members listed as destinations. Reference: HEALTH LTC Group Controller, HEALTH Evaluator Analysis: No ability to search for evacuated residents by facility. lanning Strengths The capability level can be attributed to the following strengths: Strength 1: Emergency Response Reports. With the aid of the LTC-MA Emergency Reporting System, the HEALTH LTC Group was able to identify open beds, facilities that were experiencing operational issues, and available transportation the LTC-MA members could provide to others. Strength 2: 100% Accountability. HEALTH LTC Group provided 100% accountability for all LTC-MA members. Analysis of Core Capabilities 14 Rhode Island Department of Health

15 lanning (continued) Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Emergency Response Reports Operational Issues. The HEALTH LTC Group encountered challenges in identifying the most recent operational issues from the Summary Report. Reference: HEALTH LTC Group Controller Analysis: The list was sorted by facility name and not by the time the most recent report was posted. Area for Improvement 2: Administrative Features of the LTC-MA. HEALTH LTC Group had limited exposure to the administrative components of the Emergency Reporting and LTC- MA system. Reference: HEALTH LTC Group Controller Analysis: The HEALTH LTC Group had limited exposure to: a. Completing Emergency Reporting for non-reporting facilities b. Correcting an Emergency Reporting error by an LTC-MA member c. Identifying key reports to streamline the HEALTH LTC Group activities Area for Improvement 3: Evacuation Sites and Generator Information. The HEALTH LTC Group needed the ability to quickly identify facility evacuation sites and generator information. It was identified that a process to pull up the facility and match their evacuation sites against reporting facilities would be of benefit (if the facility is on generator, they most likely would be removed as a potential evacuation site). Reference: HEALTH LTC Group Controller and DSF Controller Analysis: Many facilities have not cleanly updated their evacuation sites or generator information and HEALTH LTC Group found that being able to cross-reference the pre-selected evacuation sites to emergency reporting would streamline their processes. Influx /Surge Capacity Strengths The capability level can be attributed to the following strengths: Strength 1: Influx/Surge Capacity. From the comments on the Hotwash Conference Call and the online questionnaire it appears that many facilities either simulated or physically tested their Influx/ Surge Capacity actions. Analysis of Core Capabilities 15 Rhode Island Department of Health

16 Influx /Surge Capacity (continued) Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Triage / Intake Areas. Established Triage / Intake areas at RAF s were noted as too small or lacking proper supplies to support the area. Reference: RAF Evaluator, Hotwash Conference Call, Online Questionnaire Analysis: While receiving residents, groups noted that they were prepared to handle 1 or 2 at a time, but not the volume they were receiving (or potentially could receive). Area for Improvement 2: Surge Areas. Very few facilities actually established a full surge area to test internal capabilities to expand over licensed beds. Reference: Hotwash Conference Call and Online Questionnaire Analysis: There were nineteen (19) RAF s that stated in the Online Questionnaire that they participated in actually establishing an intake / triage area and a resident care area for surge. Vendor Activation Strengths The capability level can be attributed to the following strengths: Strength 1: Vendor Communication. During the exercises, some of the RAF s contacted their vendors to obtain availability of supplies and equipment and were able to simulate acquiring the supplies and equipment they would need accomplish an influx of residents or solve their operational issues. Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Vendor Communications. It would benefit all facilities to contact primary vendors during disaster exercises. This ensures a process is in place to communicate with vendors during a crisis. Reference: Online Questionnaire Analysis: In review of the online questionnaire it was noted that only nineteen (19) facilities had entered any comments about contacting their vendors. It was noted that not all members have updated their vendor in the LTC-MA website. Analysis of Core Capabilities 16 Rhode Island Department of Health

17 General Observations Strengths The capability level can be attributed to the following strengths: Strength 1: The HEALTH LTC Group worked very well together during the Southern Region Exercise. The group established internal teams where they worked to find additional beds (larger quantities or specific capabilities), contact facilities who have not completed their Emergency Reporting and completed interstate communications with MA DH and CT DH to request cross-border support during the event. Areas for Improvement The following areas require improvement to achieve the full capability level: Area for Improvement 1: Working in Silos. Lack of communications between work groups within the HEALTH LTC Group. Reference: HEALTH LTC Group Controller Analysis: Workgroups were established to identify open beds, communicate with RAFs, communicate with the DSF and complete patient tracking. This was a smart approach to manage the incident, but a gap developed with the lack of briefings that took place among the teams. For example, the group completing patient tracking and managing the tracking boards had excellent information on the number of residents received at each facility and operational status, while the group working on securing larger groups of beds for dementia residents was unaware of the operations taking place and made duplicative calls without the correct data. Area for Improvement 2: Briefings between DSF and HEALTH LTC Group. Briefings were limited between the HEALTH LTC Group Incident Commander and the DSF Incident Commander. Reference: HEALTH and DSF Command Center Controller Analysis: There was not a process for consistent communications with the DSF Incident Commander. This was especially true on the September 11 exercise. The September 13 exercise established briefing times but there was extensive waits for the HEALTH Incident Commander when the DSF Incident Commander called in due to the volume of activity being handled by the HEALTH LTC Group. Analysis of Core Capabilities 17 Rhode Island Department of Health

18 General Observations (continued) Area for Improvement 3: Incident Objectives / Incident Action lan (IA). The Incident Objectives were slow to be developed and were not communicated within the Incident Command disciplines of the full HEALTH LTC Group. An IA was not developed for the exercises. Reference: HEALTH LTC Group Controller and HEALTH Evaluator Analysis: The Incident Objectives were not communicated well within the HEALTH LTC Group team. There was no clear direction or development of an Incident Action lan. Area for Improvement 4: HEALTH LTC Group Staffing. It was noted that the HEALTH LTC Group had excessive staffing during the two exercises that may not be a realistic staffing model during an actual event. Reference: HEALTH Evaluator Analysis: Typical staffing for the HEALTH Medical Care Branch and the LTC Group is only 2-4 people. The LTC-MA is designed to provide the supplemental staffing. Area for Improvement 5: Waiver Approval. During the September 11 exercise, the DSF requested a variance from HEALTH to send 75 residents to Woonsocket Health and Rehabilitation Centre. The request came in from the DSF, and would not have been allowed, as Woonsocket would need to make the request directly to HEALTH (note that the V overseeing the Woonsocket Health and Rehabilitation Centre was present at the DSF and this was not known at the time). Reference: HEALTH LTC Group Controller Analysis: The DSF sent a request to HEALTH to reactivate the On Hold Beds at Woonsocket Health and Rehabilitation Centre, the sister facility of the DSF. This request was to enable 75 residents to move to this location with staff and equipment. The discussion with HEALTH was to determine if the residents were being discharged and readmitted or are they remaining residents of the DSF. The other discussion was if this would impact the Rhode Island moratorium for no new licensed beds. This process was granted by HEALTH as the residents were not going to be discharged and would be considered sheltered residents and continue to be residents of the DSF. The moratorium would not be breached and was not an issue. Area for Improvement 6: Emergency Reporting Knowledge. LTC-MA members knowledge of Emergency Reporting. Reference: HEALTH LTC Group Controller, Hotwash Conference Call Analysis: It was noted in the data entered and from the comments noted on the Hotwash Conference Call that not all members are fluent with reporting for their facility in the LTC-MA Emergency Reporting System. Analysis of Core Capabilities 18 Rhode Island Department of Health

19 General Observations (continued) Area for Improvement 7: DSF - Develop Teams within the lanning Section. The DSF s Incident Commander did not develop teams to address the transportation and staffing requirements needed to evacuate the building. Reference: DSF Controller Analysis: Through prompting by the DSF Controller, the DSF s realized their lanning Section Chief had not addressed the need to establish teams that would address: a. The transportation of staff, supplies and equipment to the RAF s. b. The staff requirements for evacuating the facility and to staff the RAF s, if requested c. Clinical staff to manage calls from the RAF s. Area for Improvement 8: Disaster Cart / Kit. LTC-MA members should develop a ortable Disaster Cart / Kit for evacuation and influx / surge. Reference: DSF Command Center and Holding Area Controllers Analysis: The DSF s did not have a kit that had key supplies and resources to facilitate an evacuation. The DSF s could not have been successful in tracking their residents in the event they were rapidly forced to the sidewalk. Area for Improvement 9: Incident Command System (ICS). All LTC-MA members need to be fluent in the Incident Command System (ICS). Reference: DSF Command Controller and RAFs Evaluator Analysis: It was clear that not all members of the LTC-MA are fluent with the ICS or the tools within the system. DSF Command staff struggled to develop an Incident Action lan, understand the roles and responsibilities of the Command Staff and Section Chiefs and understand some of the terms within the ICS. Analysis of Core Capabilities 19 Rhode Island Department of Health

20 AENDIX A: IMROVEMENT LAN (SEE EXCEL ATTACHMENT) Appendix A: Improvement lan A-1 Rhode Island Department of Health