1. Training and testing: guiding towards readiness
Jonathan Bundt, LMFT, MN CEM

2. Policies and Procedures
Sectors of Excellence
Prepared to Respond
Emergency
Plan
Policies and Procedures
Communication Plan
Training and Testing

3. Pacing ourselves

4. Critical guidance themes
Review and updates minimally on an annual basis
Training must include the initial onboarding of all employees, volunteers and others (and documented)
Demonstration of knowledge and conducting drills and exercises to test plans
By November 15 must complete:
All staff training
Participate in full scale exercise that is community based (if one is not available then facility based.)
Unique variances:
Outpatient providers do not need to provide sustenance needs
Home health and hospice must communicate evacuation needs
LTC and psychiatric residence but share plan with residents, family members and representatives

5. FIVE “R”S of exercise Realism Repetition Review of Performance
Responsibility

6. Training and Testing Program
“Must reflect the risks identified in the facility’s risk assessment…”
Potential elements to test:
Communicating facility closure. Who do you notify?
Patient tracking and record sharing
Transportation procedures
All trainings/tests must be documented and maintained for at least 3 years.
Delivery method can vary
All trainings must be documented in staff training file

7. Who is trained and what is tested
Training- education and instruction
Anyone that touches the response:
Patient, family representative
Staff (onboarding and ongoing)
Contractors
Volunteers
Testing is the operationalized process of evaluating the effectiveness of training and the response program.
Identification of gaps
Is there a written program that has been reviewed and updated, at least annually
Demonstration of knowledge

8. Unique variances in training
Multi locations must have training that is site specific
Sites can have discretion on what they want to train.
Use lessons learned from previous exercises and real world events like Hollywood Hills
Items identified from annual review
This can be new evacuation procedures
Review role of each staff person and train to the role
If you experience a real world activation of your emergency plan, you are exempt for the next year from that event.

9. Exercise program Building Blocks of Exercise Design Operations-Based
Drills
Functional (FE)
Full-scale (FSE)
Multi-Year Planning
Engaging stakeholders
Resource management
Exercise phases
Exercise types
Discussion Based
Seminars
Workshops
Tabletops (TTX)
Games
Building Blocks of Exercise Design

10. Core of exercise design Process
Initial Concept Objectives
Scenario Design
Final prep
Execution/ Evaluation
Improvement

11. Table top exercise
Group discussion that can vary in level of complexity
Identified facilitator, using a narrative
Creating a relevant scenario
Challenge statements to work on
Who should be there?
Key personnel who will be involved in decision making
Used to assess plans, policies and procedures

12. Drills Building blocks of a response Testing
Use of a fire extinguisher
Emergency notification of staff
Patient movement
Transportation and vendors resource availability unannounced
Verbal test of staff “Who do you contact if this happens…?”
Could ask a patient: “What do you do to remove yourself from a dialysis machine right now? What are your alternate service locations?”
LTC will include unannounced staff drills

13. Full Scale Exercise
Assesses facility's functional capabilities by simulating a response to an emergency that would impact the facility’s operations.
Involves multi agencies, jurisdictions and disciplines.
Multi regional elements
Realism
Utilization of a healthcare coalitions
Comprehensive documentation of:
Participants
Lessons learned
Improvement

14. documentation
TTX and FSE include the exercise plan, After Action Report, and other support documents
Documentation of attempts to identify a FSE
Improvement plan and how the emergency plan has been updated

15. Homeland security Exercise Evaluation program (hseep)
Is a capabilities and performance-based exercise program that provides a standardized methodology and terminology for exercise design, development, conduct, evaluation, and improvement planning.
Your programs DO NOT have to be compliant to the HSEEP process!

16. Full Scale Exercise management
Foundation
Planning timelines
Planning team
Planning conferences
Design and Development
Capabilities, Tasks and Objectives
Scenario
Documentation
Logistics
Exercise Conduct
Setup
Presentations
Personnel
Evaluation
Hot wash and debrief
After action report/ Improvement plan
Improvement plan
Tracking and planning

17. Planning conferences Concept and Objectives (C&O)
Type, scope, objectives
Initial Planning Conference (IPC)
Lays foundation
Assigns responsibility to planning team members
Mid Term Planning (MPC)
Resolves logistical and organizational issues
Master Scenario Events Lists (MSEL)
Final Planning Conference (FPC)

18. Documentation Exercise plan (EXPLAN)
Controller and Evaluator (C/E) Handbook
Master Scenario Events List (MSEL)
Briefings
Exercise Evaluation Guides (EEG)

19. Evaluation Evaluators
Whom are they? What is their role? Helping them be successful
Debriefing
Small and large groups
Role players
“Hot wash”

20. After Action Report and improvement plan
AAR
Pulling it together
AAR meeting
Final finances
Documentation ownership
Improvement Plan
Tracking improvement
Keeping the momentum
Returning to training and testing

21. Here we go: lets start a Tabletop exercise

22. Participant Expectations
Scribe for group to identify discussions, decisions and lessons learned
No stress and non-judgmental exercise environment
Don’t make too many assumptions about what you can do and what is understood about the scenario
Don’t over think the current situation
Residential versus home or outpatient programs will have different elements. Some agencies will have elements of both!

23. Exercise Objectives
Assess the capability to identify and notify staff of current situation. How and what is communicated?
Identify what emergency plans are available to activate for an immediate response to the emergency.
Develop plans that don’t exist that will have to be developed on the fly for your agency.
Maintain situational awareness of safety issues for residents/patients, staff, volunteers, family members and visitors.

24. Initial Incident Information
Insert your reality:
Facility flooding
Utility outage: power and water
Regional impact
Decision to evacuate the facility has been made
Incident is occurring in real time of today and this time
Deliver at 12:00 hours
There has been a mechanical failure in the local water supply. The city is unable to provide water to not only the long term care facility, but to the entire city at this time. The backup water supply plan that the city has in place is also impacted due to chemical contamination that is associated with the initial mechanical failure. At this time, the city is advising all consumers of water to find alternate sources of water for the next 24 hours.
The local convenience stores, grocery stores, and other retailers are already rationing their available water. The ration is two cases per person, per purchase, with a total limit of 6 cases total per day, and only for those who have an identification card or utility bill that states that they are a city resident. All retailers within an hour driving distance from the facility are already reporting that their stock is depleted.

25. Contact information
Jonathan Bundt