After-Action Report/Improvement Plan Template



Severe Weather Tabletop ExerciseAfter-Action Report/Improvement PlanJuly 21, 2017 from 9AM-11AMClark County Health Care CoalitionThe After-Action Report/Improvement Plan (AAR/IP) aligns exercise objectives with preparedness doctrine to include the National Preparedness Goal and related frameworks and guidance. Specific to this report, the exercise objectives align with ASPR’s National Guidance for Healthcare Preparedness and the Hospital Preparedness Program Measures. Record of Change09/28/2017Created AAR/IPC.Conover, CCCHDExercise OverviewExercise NameSevere Weather Tabletop ExerciseExercise DatesJuly 21, 2017 ScopeThis exercise is a discussion based Table Top Exercise (TTX), planned for two (2) hours among Health Care Partners in Clark County, Ohio. Core Capabilities2017- 2022 Health Care Preparedness and Response Capabilities, ASPR; 2. Health Care and Medical Response CoordinationCapability 3. Continuity of Health Care Service DeliveryObjectivesCap 2-Objective 3: Coordinate Response Strategy, Resources and CommunicationsCap 3-Objective 2: Plan for Continuity of OperationsCap 3-Objective 3: Maintain Access to Non-Personnel Resources during an EmergencyThreat or HazardSevere Weather/TornadoScenarioFor the purposes of this exercise, the main driver will be a severe weather event, including a tornado that causes damage to the home office facility or residential care facility. Additionally, many other response needs are taxing the availability of Emergency Medical Services (EMS). Traditional communication systems and transportation systems are disrupted. SponsorClark County Emergency Management Agency (EMA), OhioParticipating OrganizationsHealth Care Partners within the Clark County Health Care CoalitionPoint of ContactClark County EMASelinda Sizemore (937) 521-2177; ssizemore@ Ken Johnson (937) 521-2178; kjohnson@SummaryThis exercise was a tabletop exercise conducted among agencies that serve clients within their homes. The severe weather scenario facilitated discussion regarding the activities of the home health and hospice agencies. The discussed activities addressed both staff safety and client safety during attempts to continue operations in less than optimal circumstances. A demonstrated benefit of this successful exercise was the idea sharing that occurred between agencies. Strengths and areas for improvement are noted below. Analysis of Health Care Preparedness (HPP) CapabilitiesThis table includes the exercise/event objectives, aligned HPP capabilities, and performance ratings for each HPP capability as observed during the exercise or real world response and determined by the evaluation/AAR team.Table 1. Summary of HPP Capability PerformanceObjectivePHEP/HPP CapabilityPerformed without Challenges (P)Performed with Some Challenges (S)Performed with Major Challenges (M)Unable to be Performed (U)Identify and coordinate resource needs during an emergency. Capability 2: Health Care and Medical Response CoordinationXCommunicate with health care providers, non-clinical staff, patients and visitors during an emergencyCapability 2: Health Care and Medical Response CoordinationXContinue administrative and finance functionsCapability 3. Continuity of Health Care Service DeliveryXPlan for health care organization shelter in placeCapability 3. Continuity of Health Care Service DeliveryXAssess supply chain integrityCapability 3. Continuity of Health Care Service DeliveryXAssess and address equipment, supply, and pharmaceutical requirementsCapability 3. Continuity of Health Care Service DeliveryXThe rating scale includes four ratings:Performed without Challenges (P): The PHEP functions, tasks, and performance measures or the HPP activities, objectives, and performance measures associated with the capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance 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. Performed with Some Challenges (S): The PHEP functions, tasks, and performance measures or the HPP activities, objectives, and performance measures associated with the capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance 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.Performed with Major Challenges (M): The PHEP functions, tasks, and performance measures and or the HPP activities, objectives, and performance measures associated with the 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 Performed (U): The PHEP functions, tasks, and performance measures or the HPP activities, objectives, and performance measures associated with the capability were not performed in a manner that achieved the objective(s).Objectives of the Exercise: Identify and coordinate resource needs during an emergency. Communicate with health care providers, non-clinical staff, patients and visitors during an emergencyContinue administrative and finance functionsPlan for health care organization shelter in placeAssess supply chain integrityAssess and address equipment, supply, and pharmaceutical requirementsStrengths Identified During Discussion:Safety of staff is a demonstrated priority among all participating health care agencies. (Workforce development addresses many topics including gun safety, drugs, domestic violence, etc.) Situational Awareness and information sharing between agencies and staff is well demonstrated.Hospice of Miami County has identified a collaborative plan with American Red Cross to establish a Hospice Room within a shelter. Among Ohio’s Hospice offices, idea sharing is occurring with regards to preparedness for staff and clients.Agencies working in rural areas demonstrate resilience in addressing challenges such as increased risk of flooding in hilly areas; cell service spotty due to terrain, etc. Opportunities for Improvement Identified During Discussion:Although some agencies had a well-established policy for prioritizing clients for contact during an emergency, others may benefit from formalizing a process. Increase familiarity with identified shelters in the areas where clients are located by working with local American Red Cross or Emergency Management Agency.Planning for mass dispensing needs to occur.Integration of emergency plans, policies and procedures among all levels of agency staff, as current education and involvement is limitedReview existing Memorandums of Understanding (MOUs) with hospitals, O2 providers, generators, etc. Notes for Participants:Each participating agency is asked to review the overall strengths and areas for improvement noted above and customize these lists according to the specific needs of the agency. The opportunities for improvement should then be included in the Improvement Plan in Appendix A. It is important that the issues identified for Improvement are addressed through subsequent planning, training and exercise. Appendix A: Improvement PlanThis IP has been developed specifically for Clark County Health Care Coalition as a result of Severe Weather Tabletop Exercise conducted on July 21, 2017 from 9AM-11AM.Issue/Area for ImprovementCorrective ActionPrimary Responsible OrganizationOrganization POCStart DateCompletion DateEstablish or Review a formalized protocol for contacting homebound clients during an emergencyReview current practice or protocol Home Health and Hospice AgenciesResearch best practices or standards Home Health and Hospice AgenciesRevise current practice as needed; implement and trainHome Health and Hospice AgenciesIdentify and familiarize agency with emergency shelter plans within the jurisdictionConsult with local Emergency Management Agencies and Red CrossHome Health and Hospice AgenciesEstablish plans for shelter care of Hospice ClientsHome Health and Hospice AgenciesPlan for Mass Dispensing in a Biological ThreatWork with local health department to become a Closed Point of Dispensing (POD) for medication distribution for staff and staff families. Home Health and Hospice AgenciesDiscuss possibilities of serving clients in mass dispensing scenarios. Discuss with local health department. Home Health and Hospice AgenciesIncorporate into training and exercise. Integrate emergency plans, policies and procedures throughout agencyRevise staff trainingHome Health and Hospice AgenciesInvolve staff in exercises/drillsHome Health and Hospice AgenciesReview and Execute MOU’s for the agency’s emergency response.Review existing MOU’s for accuracy, relevanceHome Health and Hospice AgenciesPursue additional formalized agreements for services in emergenciesHome Health and Hospice AgenciesAppendix B: Exercise/Event ParticipantsParticipating OrganizationsLocal GovernmentClark County Combined Health DistrictClark County Emergency Management AgencyNon-Government Coalition Members and PartnersBethel Township FireInterim HealthcareOhio’s Hospice/Ohio’s Hospice of Dayton/ Hospice of Miami CountyOhio’s Hospice/Hospice of Miami CountyOhio’s Hospice/Ohio’s Community Care Hospice (referenced as Wilmington in this document)OtherConsultant/SMEAppendix C: AcronymsTable E.1: AcronymsAcronymMeaningAAR/IPAfter-Action Report/Improvement PlanARCAmerican Red CrossASPRAssistant Secretary for Preparedness and ResponseCCCHDClark County Combined Health DistrictDHSU.S. Department of Homeland SecurityEOCEmergency Operations CenterEMAEmergency Management AgencyEMSEmergency Medical ServicesESFEmergency Support FunctionGDAHAGreater Dayton Area Hospital AssociationHCCHealth Care CoalitionHSEEPHomeland Security Exercise and Evaluation ProgramIAPIncident Action PlanIPImprovement PlanMOUMemorandum of UnderstandingODHOhio Department of HealthPHEP/HPPPublic Health Emergency Preparedness/Health Care PreparednessPOCPoint of ContactSitManSituation ManualSMESubject Matter ExpertTTXTable Top ExerciseAppendix D: Exercise/Event SummaryDayExercise TimeEvent/Action1 08:30Severe Thunderstorm Warning109:30A Tornado Warning is IssuedInject Detail:July 12th 2017 around 0830 AM. It’s a muggy, overcast day with a very light breeze. Temperatures are projected to reach 92*F, with a low of 81*F. The National Weather Service has issued a severe thunder storm warning for Clark County. NWS is advising several strong storm cells capable of producing high winds, excessive rain, and pea sized hail is traveling east at 25 to 35 mph. The National Weather Service has deemed the first cell unstable as it gains speed and strength. This cell is expected to reach your area around 10 AM.Is this an incident? How do you receive information? What plans do you activate? What are the triggers? Who activates them, and how is that communicated?Discussion 1Hospice Dayton: Yes; this is an incident; need to start planning. Weather radios at each desk that gets tested regularly. Emergency Plans available on intranet. Triggers on a severe thunderstorm warning. Inpatient is paged every 30 minutes on overhead. Send home brochures on tornado safety with home care staff. Communication via weather radios and e-mails.Hospice Wilmington: Most staff in the field. Weather apps. Small staff issues. Problems with cell signal. Trigger severe thunderstorm warning. In need of “what if” plans. Currently, they do provide patient education for disasters. Hospice Miami County: Response similar to Hospice of Dayton. Uses “one-call” for tornado warning.Interim: Yes; this is an incident to start planning. Use one- call and email. Triggers on a severe thunderstorm warning.07/21/170942The first of several storm cells reach your area. Local media is advising to take cover07/21/170946Local media confirms a tornado touchdown07/21/170948Residential power is lost to several areas, as well as your office. Generators have failed to engage07/21/170950Significant damage is sustained to your office from the flying debris07/21/170955Immediate threat has cleared the area07/21/171015Tornado warning has been lifted.Inject Detail: Emergency services are tied up with search and rescueMany roads are blocked by trees and debris. Heavy rain continues with the next passing storms and rain water is coming into your office.You are starting to obtain a better picture of damages and strive for accountability.Has your staff been trained to operate the backup generator at your office, and troubleshoot issues? Who are the internal and external communications with? How are internal and external communications taking place? How do you prioritize patient contact? What are the procedures for patients you are unable to make contact with?DiscussionHospice Dayton: Only inpatient required to have generator. No other has generators. Staff trained in troubleshooting, but not always on duty. On call generator people 24/7. Offsite buildings don’t need to run. Can move to another building. Contracts with 02 providers for emergency provision. Hospice Wilmington: Does not have a secondary place for power. Does not fall under joint commissionHospice Miami County: MOU with Upper Valley for backup generators. Able to use their servers. Acuity policy; locate patients in affected area and go to most critical first.Interim: Several locations. Can switch counties and re-route.Inject Detail: Staff is trying to make contact and prioritize patient care. Office generator was made operational through troubleshooting. Inside temperatures at patient homes are a problem. Many patients have medications dueWhat patients are contacted and what procedures are followed if they're unreachable? How long can you sustain current operations in austere conditions at your office? How will you document your medications and care if electronic charting is unusable? What medical care are you continuing under emergency operations? Are you using altered standards of care?If yes, describe.Discussion: Hospice Dayton: For shelters they provide everything, just need 1 room and a fridge for medications. Hospice Wilmington: Contact emergency contact on patient’s face sheet. Phone tree already established. Patients having cell phones and not land lines, now with no cell service can be an issue. Phone tree needs updated. Recommend having the local EMA come in to help identify shelters in the Wilmington area. Hospice Miami County: Dispatch their staff to residence if contact isn’t able to be made. One Call now. Pre-planned with local fire chiefs on making contact with patients. Have fire/ems transport to safe place, then Medtrans or hospice will transport.In the past, Miami has put clients in motels; American Red Cross (ARC) in Miami County has agreed to open a Hospice Room inside a shelter as needed; (emphasizes the benefit of relationships with ARC and discussion) Hospice would staff the room and bring the beds and ARC would provide the room and refrigeratorInterim: Sends staff out to red patients and then call emergency contacts.General Discussion: Inject Detail: Injured have been transported by ambulanceYou have accounted for all staff members and patientsEmergency crews will have all roadways cleared by morningDo you have agreements established with other facilities or agencies for assistance? If non-emergency transport is needed, how are they to be transported? Do you have agreements for equipment if shortages arise? Do you have any long term relocation plans?Discussion: Hospice Dayton: Documentation by electronic document. Then sync to server. Can work from pc without internet and sync later. Fail proof unless laptop is destroyed. Paper used as backup. Supplies all meds. Could use volunteers to transport meds in emergency, and agreements and waivers in place. Contracted with pharmacy firm to supply. Have some bottles of water on hand, but not enough to sustain a 52 unit bed. Hospice Wilmington: Gives instruction over the phone. Medications are limited and may run out. Hospice supplies to all meds. Weather ready updates; contacts patients about snow storms, bad weather, etc. Make sure you have extra 02 cylinders, enough meds for several days, etc.Hospice Miami County: Documentation by electronic document. Then sync to server. Can work from pc without internet and sync later. Fail proof unless laptop is destroyed. Paper used as backup. Supplies all medsInterim: Local Pharmacy provides medications; gives reminders and makes sure they don’t run out. Fire and disaster preparedness information sent home. 72 hour kits, power outages, oxygen, food storage and how long it lasts, and handouts given. All hospices not giving this. Just Wilmington, but talking about needing it for Ohio.Home safety brochures given out by all hospices. (trip hazards, 02, etc.) ................
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