CONTROLLER AND EVALUATOR TRAININGSeptember 30, 2014

Los Angeles County Emergency Medical Services

Agency

STATEWIDE MEDICAL AND HEALTHFUNCTIONAL EXERCISE

Agenda Exercise Overview

o Objectiveso Scheduleo Implementation

Simulation Cell (SimCell) Control Instructions Evaluation Instructions

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EXERCISE OVERVIEW

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Program Phases – Building Block Phase 1) Multimedia training, including:

o Disaster preparedness and responseo Medical and health coordinationo Requesting medical and health resourceso California Public Health and Medical Emergency Operations Manual

training

Phase 2) Organization specific self-assessment tools to identify strengths and weaknesses

Phase 3) A tabletop exercise to discuss current plans, policies and procedures

Phase 4) A functional exercise to test current plans, policies and procedures

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Exercise Highlights Thursday, November 20, 2014 Exercise Play: 9:00 AM – 12:00

PM* Focus:

o Coordination of surveillance activities and health system capabilities anticipated when managing a medical surge caused by possible MERS-CoV infections

Play throughout the Stateo Los Angeles County Participants

• Hospitals• Clinics• Long Term Care Facilities• Surgery Centers• Dialysis Centers• Ambulance Providers• Emergency Management Providers

(DMH, DPH, DHS, CEOC, LAC-EOC)• LEMSA• Home Health

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Objectives Organized by Discipline and Capability

o Operational Communicationo Public Health and Medical Services

(Formerly Medical Surge/ Epidemiological Surveillance and Investigation)

o Operational Coordination(Formerly Emergency Operations Center Management)

o Public and Private Services and Resources(Formerly Volunteer Management and Donations)

Marry State and County objectives & capabilities

Each sector selected its own objectives Each participant organization can tailor to

their needs

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Scenario Two individuals have been diagnosed with MERS-

CoV one nine days ago and a second three days ago o Significant numbers of patients with influenza like illness

inundate the healthcare system requesting testing and treatment for MERS

o Increased numbers of ILI cases with a 10% increase in admissions with acute respiratory illnesses 

Guidance on specimen collection, laboratory techniques, and necessary levels of isolation and personal protective equipment

Ambulance companies and 9-1-1 system are overwhelmed

TIP: Scenario specifics contained in the MSEL should not be given to players in advance of the exercise.

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Exercise ScheduleTime Personnel Activity

November 20, 2014

7:30 am Selected controllers and exercise staff members

Exercise site setup

8:00am Participants (players, observers, actors)

Registration

8:15am Controllers and evaluators Communications check

8:30am Participants Participant briefings

9:00am All Start of exercise

12:00pm All End of exercise

Immediately after the exercise

Participants, controllers, and evaluators

Hotwash

December 18, 2014

9:00am-12:00pm for all participants

 

Controllers, evaluators, and Exercise Planning Team members

Exercise Evaluation Conference at LAC DHS located on 10100 Pioneer Blvd., Santa Fe Springs,

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Exercise Documentation

Controller and Evaluator (C/E) Handbook Exercise Plan (ExPlan) Communications Directory (including SimCell)

o Sent directly to participants via email Master Scenario Events List (MSEL) Combined EEG/After Action Report/Improvement

Plan Template Participant Feedback Form-Coming soon Website: http://

dhs.lacounty.gov/wps/portal/dhs/ems/disastermedicalservices

Exercise materials provided on EMS website Can be used as templates for future efforts

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Exercise Participants Players: Active role in performing their regular roles

and responsibilities in response to the scenario. Individuals and performance are evaluated.

Controllers: Controllers plan, manage and ensure the integrity of the exercise. Direct the pace, provide key data to players, and may prompt certain player actions to ensure exercise continuity. o Simulators: Simulators play the role of non-participating

organizations or individuals. Provide injects to players to prompt actions in accordance with scenario. Operate from the Simulation Cell (SimCell), but may occasionally have face-to-face contact with players.

Evaluators: Assess the performance of players and the design of the exercise and provide feedback on designated functional areas.

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Exercise Participants (Cont.)

Actors: Realistically act out the roles of individuals involved with or impacted by the scenario for players to directly respond to in person. Usually asked to evaluate the performance of players as well.

Observers: Observers do not play in the exercise, nor do they perform any control or evaluation functions. They are not to interfere with exercise play.

Support Staff: Individuals who perform administrative and logistical support tasks during the exercise (e.g., registration, catering).

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Exercise Implementation

Assumptionso Real-world emergencies take priorityo Exercise participants will comply with real-

world response procedures unless otherwise directed

Exercise Communicationso Exercise Language

Site Safety and Security

Exercise Identification/Credentials

Simulation Cell (SimCell)

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SimCell Operations Three major activities

o Delivering injects to players (outgoing)o Simulating non-participating entities

(inbound)o Documenting participant responses

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SimCell Positions SimCell Lead Controller

o Track and coordinate all scenario eventso Identify how problems can be resolved o Directs and provides guidance to simulatorso Can be contacted by Controllers at play sites regarding

exercise status Simulators

o Track injects, participant calls into the SimCell, and associated follow-up responses

o Ensure realism and accuracy in all exercise communication

o Place injects, answer phones and respond to player questions, create new injects to encourage additional participation

o Conduct research and provide explanations for observed player actions during the exercise

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SimCell Operations SimCell Limits

o Only simulating non-participating entities• If they’re playing…contact them directly!

o Players need to identify who they want to talk to (be specific)

o Will not make decisions for playerso May have limited knowledge/expertiseo May need to do follow up and call back

Use the Communications Directory provided by EMS via email to registered participants-emailed to functional and full scale participants only- USE for exercise only

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SimCell Responsibilities Before the Exercise

o Review any emergency plans, procedures, and protocols available to you relevant to your assignment

o Review the exercise materials issued to you, including the objectives, scenario, MSEL/injects, and evaluation forms

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During the Exerciseo Ensure all planned injects are submitted to the

appropriate agencies on time (unless otherwise instructed) and in the correct format

o Receive player communications, then write, coordinate, and transmit appropriate responses in a timely manner

o Ensure SimCell operations are coordinated and congruent with the overall exercise operations

SimCell Responsibilities (Cont.)

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SimCell Responsibilities (Cont.)

During the Exercise o Keep the SimCell lead controller apprised of

developments, problems, issues, or concernso Attempt to accurately portray the information

contained in inject forms to the playerso Record all calls received and made on the

SimCell Activity Log o Any new injects developed for the exercise

should be submitted to the SimCell Lead Controller for approval before being used in the exercise

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SimCell Responsibilities (Cont.)

Phone Instructionso When answering a phone in the SimCell or at

another simulated entity location always answer with “This is the SimCell”

o Inquire to the participant regarding their name, agency/facility and who they are trying to reach if they do not provide this information

o Ensure you re-iterate “This is an exercise” prior to providing any answers or feedback to participants

Exercise Control

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Controller Purpose Ensure the integrity of the exercise Responsibilities

o Exercise mechanics and functionalityo Deliver injects to drive playo Provide Player Briefingo Objectives are being meto Actor managemento Participant behavior/activitieso Safety/securityo Facilitate Hotwash

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Controller Positions Exercise Director

o Final authority on all aspects of the exercise, including starting, modifying, or ending the exercise

o Works with the Senior Controller to ensure the exercise runs smoothly and all objectives are met

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Controller Positions (Cont.)

Senior Controllero Coordinates with the Exercise Director on exercise

control and safety issueso Monitors activities at each exercise venue o Tracks whether objectives have been met or

require further attention Controllers

o Each exercise venue will have its own Controller(s)o Responsible for keeping the exercise on schedule

and suggesting potential modifications or injects o The SimCell will have a lead controller who is

responsible for managing the SimCell

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Controller Responsibilities

Before the Exerciseo Review applicable plans and procedures that

will be activated during the exerciseo Know the scenario and MSELo Arrive at the venue 60 minutes before StartEx o Provide the Player Briefing

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Controller Responsibilities (Cont.)

During the Exerciseo Locate necessary communications equipment

and test it to ensure systems are operationalo Monitor flow and sequence of events during

play according to the MSELo Manage the flow of exercise play

• “Eyes and ears” of the SimCell and Exercise Director• Controllers must work with the SimCell to maintain

appropriate exercise pacing• “Speed up” play if Players aren‘t challenged• “Slow down” play if Players are overwhelmed

• Have patience, allow exercise to play outo If possible, capture notes to assist Evaluators

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Controller Responsibilities (Cont.)

Conduct a Hotwasho Held immediately following EndExo Hotwash slide contained in Player Briefingo Opportunity for PLAYERS to comment on

their experience• What went well?• What needs improvement?

• Plans, organization, equipment, training, exercise

• Any surprises?• Improvements to exercise

implementation?o Distribute and collect Participant Feedback

Forms

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Player Instructions Controllers ensure Players are ready to

participate Player Briefing Highlights

o Scenario (provided on website)o Exercise Objectives (provided on website)o Exercise Mechanics/Functionality

• Start time• End Time• Description of Exercise staff

o Rules of Play• Real world vs Exercise language

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Player Instructions (Cont.)

Key Messages & Enforcemento Will not have prior knowledge of the scenario

beyond the contents of the Player Briefing

o Must understand the scope of the exercise and which organizations are participating

o Expected to recognize that certain artificialities are built into the scenario to meet exercise objectives• e.g., Instruct players not to fight the scenario

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Player Instructions (Cont.)

Key Messages & Enforcement (Cont.)

o Need to follow real world response procedures and act as if the emergency were real

o Demonstrate all actions necessary to meet exercise objectives

o Players must receive information from their own sources (e.g., other players or SimCell)

Should “verbalize” their responses and maintain activity logs

Turn in all documentation to the Controller or Evaluator

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Participant Interaction Players direct requests for additional info

to Controllers and the SimCell Players and Controllers/Evaluators will not

engage in casual conversation Players must adhere to all Controller

instructionso “Controller Prerogative” may countermand a

Player’s actions to preserve the continuity, integrity and/or objectives of the exercise

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Participant Interaction (Cont.)

Controllers only provide Players with info when specifically designated (e.g., injects)

Controllers and Evaluators should not provide players with feedback or guidance on their actions/ performance

Evaluation

Evaluation Purpose The fundamental purpose of the exercise

Evaluators collect data, conduct analysis, and provide findings/recommendations

Evaluator findings/recommendations based on evaluation guides, plans/procedures, personal expertise and experience

Provide the foundation for the After Action Report (AAR) and Improvement Plan (IP)

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Evaluator Guidance No fault exercise

o Learning environmento Judge the plans and capabilities, NOT the

playerso Identify Lessons Learned

• Best Practices• Areas for Improvement

o Assess the level of preparednesso Ensure opportunities for Player demonstration

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Evaluator Guidance (Cont.)

Observe and Recordo During and after exerciseo Tips and Key Focus Areas:

• Activities that directly relate to goals and objectives

• Expected actions associated with Injects• Decision-makers and key decisions• Critical events/initiating scenario events• Deviation from plans/procedures• Include times (both start and end)• Use the Exercise Evaluation Guide

(EEG)

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Evaluator Guidance (Cont.)

Tips and Key Focus Areas (Cont.)

o What to look for• What happened? When?• How did Players coordinate?• How did Players use plans & procedures?• Adequacy of equipment/facilities/resources to support

task accomplishment

o Focus on outcomes and pathways• Do not focus exclusively on specific tasks• Focus on what they accomplished and how they

accomplished it

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Evaluator Guidance (Cont.)

Be aware ofo The integration of different functionso Coordination of the overall responseo Timeline

• Discrepancies may indicate issues

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Evaluator Guidance (Cont.)

Before the Exerciseo Review the appropriate plans, procedures, and

protocolso Attend required briefingso Review and be familiar with the appropriate exercise

materials o Be familiar with After-Action Report (AAR) requirements

and write up templateso Report to the exercise location at the time designated

in the Exercise Schedule o Obtain or locate necessary communications equipment

and test it to ensure satisfactory communication between Controllers and the Exercise Staff

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Evaluator Guidance (Cont.)

During the Exerciseo Capture detailed noteso Position yourself so you can hear/seeo Ask questions of players as necessary

• Don’t interfere with exercise playo Notify the Controller of any exercise issues

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Evaluator Guidance (Cont.)

After the Exerciseo Capture notes during the Hotwasho Collect documentation from players

• Player Logs• Inject/MSEL forms• Player ICS forms, Action Plans, Press Releases, etc.

o Collect and review Participant Feedback Formso Attend C/E Debrief at your siteo Submit evaluation write-ups

• Identify strengths and areas for improvement for each objective

• Populate Improvement Plan (IP)

Post-Exercise Activities

Post-Exercise Activities Attend Exercise Evaluation Conference (EEC)

o Date: Thursday, December 18, 2014o Time: 0900-1200 (Registration at 0830)o Location: LA County EMS Agency, Hearing Room 10100 Pioneer Blvd, Santa Fe Springso Attendees include Senior Controller/Evaluator

• Max 2 persons per facility/organization

o Facilitated discussion of all aspects of the exercise• Design process• Review exercise in accordance with objectives and

observations• Feedback from Hotwash and Participant Critiques

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Post-Exercise Activities (Cont.)

Exercise Evaluation Conference Formato ONE representative to speak for each agency/

organizationo Provide overall summaryo Provide 3 practices to “sustain” and

recommendations on how to sustain themo Provide 3 practices to “improve” and

recommendations on how to improve themo A mix of organization-specific and system-wide

strengths and areas for improvement

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Evaluation Write Ups After-Action Report (AAR) Template

o Identify strengths and areas for improvement for each objective

o Populate Improvement Plan (IP) Due January 22, 2015

o Email to Gary Chambers, LA County EMS Agency gchambers@dhs.lacounty.gov

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In Conclusion Review the:

o Controller/Evaluator Handbooko MSEL and scenarioo Plans and procedures

Bring appropriate materials with you o Clipboards, note pads, pens, camera,

good shoes, etc.

Be early for assignments Be prepared to complete or

participate in activities after the exercise Respect your role and take your responsibilities

seriouslyo Exercise success is more dependent on the exercise staff than

on the players46

The EEG/AAR/IP Form

“One form to make it simple”

First few pages are for the Exercise Evaluation Guides (EEGs) for use by the evaluators during the exercise

Middle Pages are the After Action Report (AAR) to be completed by the Lead Evaluator

Last pages are the Improvement Plan (IP) to be completed by organizational management staff

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The Evaluator’s Impression

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Strengths and Improvement Needed

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Participant Feedback Form-Summary

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Participant Feedback Form-Comments

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The Improvement Plan

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Participant Feedback FormAppendix E- Exercise Plan

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Thank you!

Please contact for EEG/AAR/IP Form information or instruction:Terry Crammer562-347-1645

tcrammer@dhs.lacounty.gov