Section 9

Education, Training and Exercises

Table of Contents

9.1. Purpose 9 - 1

9.2. Philosophy 9 - 1

9.3. Preparedness Plan Training Development 9 - 1

9.4. Competency-Based Training Program Development 9 - 1

9.4.1. Organizational Competencies 9 - 2

9.4.2. Target Audience and Sample Competencies 9 - 2

9.4.2.1. All Employees Job Group 9 - 2

9.4.2.2. Facility Leaders Job Group 9 - 3

9.4.2.3. Patient Care Providers Job Group 9 - 4

9.4.2.4. Emergency Program Managers Job Group 9 - 5

9.4.3. Training and Exercise Program Assessment 9 - 5

9.5. Education and Training Resources 9 - 6

9.5.1. Education and Training Resources for Leaders and Key Operating
Unit Managers 9 - 6

Figure 9.1: Independent Study Courses Required 9 - 7

9.5.2. Education and Training Programs for Patient Care Providers 9 - 7

9.5.2.1. Medical Response to Weapons of Mass Destruction (WMD) 9 - 7

9.5.2.2. Veterans Health Initiative 9 - 8

9.5.2.3. Other Training Resources for Care Providers 9 - 8

9.5.3. VHA Education and Training Program for Decontamination Teams 9 -
9

9.5.4. Education and Training Programs for Emergency Program Managers
9 - 10

9.5.4.1. Emergency Management Program Guidebook Training Resource 9 - 10

9.5.4.2. FEMA Emergency Management Training Courses 9 - 10

9.6. Exercise Programs 9 - 11

9.6.1. Purpose 9 - 11

9.6.2. Types of Exercises 9 - 12

9.6.2.1. Orientation Seminars 9 - 12

9.6.2.2. Drills 9 - 12

9.6.2.3. Tabletop Exercises 9 - 12

9.6.2.4. Functional Exercises 9 - 12

9.6.2.5. Full-Scale Exercises 9 - 13

9.6.3. Exercise Development Process 9 - 13

9.6.3.1. Establishing the Base 9 - 13

9.6.3.2. Exercise Development 9 - 13

9.6.3.3. Conducting the Exercise 9 - 13

9.6.3.4. Exercise Evaluation and Critique 9 - 13

9.6.3.5. Exercise Follow-up 9 - 13

9.7. Example Scenarios 9 - 14

9.7.1. Flood 9 - 14

9.7.2. VA/DOD Contingency Hospital System 9 - 15

9.7.3. Mass Casualty Incident 9 - 16

9.7.4. Hurricane 9 - 17

9.7.5. External HAZMAT Plume 9 - 18

9.7.6. Bombing With Prior Threat 9 - 20

9.7.7. Earthquake 9 - 21

*Enclosures*

1\. New Employee Orientation Guideline for Emergency Program Managers
9 - 25

2\. VA/DoD Exercise 9 - 31

3\. Example Federal/State/Local Exercise Plan 9 - 33

Annex A - Level of Participation

Annex B - Exercise Observers

Annex C - Communications

Annex D - Security

Annex E - Public Affairs

Annex F - Brief Scenario Template

4\. Example Exercise Area Diagram 9 - 45

5\. Tabletop Exercise Template 9 - 47

6\. Example Tabletop PowerPoint Template 9 - 49

7\. Example Exercise Critique/After Action Report 9 - 51

8\. FEMA's Guide to Emergency Exercises CD

Section 9

Education, Training and Exercises

9.1. ***Purpose***. The purpose of this Section is to provide guidance
for regular training to staff on their responsibilities during
emergencies and disasters with the goal of reducing uncertainty and
improving effectiveness. This guidance applies to staff that are
responsible for developing and conducting emergency management
education, training and exercises at VHA Central Office (VACO), Veterans
Integrated Service Networks (VISNs) and VA Medical Centers (VAMCs).
These responsibilities are often shared by several offices (e.g.,
Education, Safety, Quality Management) and are accomplished through a
sub-group of the Emergency Management Committee (EMC). This information
is intended to build upon training that is currently offered, not
replace it.

9.2. ***Philosophy***. The Veterans Health Administration currently does
not mandate that employees receive education and training in emergency
management beyond that required by JCAHO. In some cases other
requirements exist, such as for members of Decontamination Teams who are
subject to OSHA training requirements, and VHA officials for Continuity
of Operations Planning (COOP). Regardless, employees who are assigned
roles and responsibilities in the Emergency Operations Plan (EOP) must
be given the opportunity to become familiar with what is expected of
them. This can be accomplished through a comprehensive preparedness
program that includes standards development, education, training,
exercises and corrective action. Facility preparedness for the emergency
situations should be considered a continuous cycle of education,
exercises, corrective actions and program improvement.

9.3. ***Preparedness Plan Training Development***. The Emergency
Management Committee (EMC) sets policy for the VAMC or VISN emergency
management program, including setting standards for staff education and
training. Examples of important issues that should be considered
include:

-   Identification of training needs for each job group, including
    appropriate standards and accepted practices.

-   Establishment of basic training requirements for all personnel, the
    Incident Management Team and specialized activities (such as
    decontamination, patient reception, bomb threat and fire response).

-   Identification of an annual schedule of training and exercise
    activities needed to support the Emergency Operations Plan.

-   Identification of training responsibilities.

-   The funding and staffing of the preparedness-training program.

9.4. ***Competency-Based Training Program Development***. Training,
education and exercises must meet the unique needs of the facility and
the community in which it resides. The activities must also be tailored
to develop the knowledge, skills and abilities of the various target
audiences.

9.4.1. *Organizational Competencies*. The overall objectives that guide
the organization's response to and recovery from emergencies include:

-   Continuity of patient care operations.

-   Safety of patients, visitors and staff.

-   Support to the community and the Nation.

-   Preservation of vital records and property.

9.4.2. *Target Audiences and Sample Competencies*. Four target audience
job groups have been identified along with a set of sample competencies
that VAMCs and VISNs can use as a basis for their training needs
assessments. These include:

-   All employees

-   Facility Leaders

-   Patient Care Providers

-   Emergency Program Managers

All employees play a role in the emergency response setting, even if it
is simply to maintain or enhance current operations for patients within
the system and to anticipate and prepare for increased demands resulting
from the emergency situation. Expectations of facility personnel can
more easily be addressed by the emergency plan and response process by
dividing all personnel into the four job groups noted above. These four
job groups incorporate levels of training that progressively increase
with level of responsibility. The expectations, functions and
responsibilities of each of these groups are addressed below.

9.4.2.1. [All Employees Job Group]{.underline} - Includes all personnel
with assigned job positions within the Emergency Operations Plan and
supervisory staff who may be required to perform the duties of an
initial Incident Commander. The competencies within this group are
referred to as *core competencies* necessary as a base for every
position within the organization. Emergency response and recovery
competencies for this job group include:

-   Utilize general Incident Command System (ICS)/Incident Management
    System (IMS) principles during incident response and recovery.

-   Recognize situations that suggest indications for full or partial
    activation of the healthcare facility's Emergency Operations Plan
    (EOP), and report them appropriately and promptly.

-   Participate in healthcare facility mobilization to rapidly
    transition from day-to-day operations to incident response
    organization and processes.

-   Apply the VHA core mission statement to actions taken during
    emergency response and recovery.

-   Apply the VHA Code of Ethics
    ([vaww1.va.gov/vhaethics/download/code.doc](http://vaww1.va.gov/vhaethics/download/code.doc))
    to actions taken during emergency operations.

-   Execute personal/family preparedness plans to maximize availability
    to participate in the facility's emergency response and recovery.

-   Respond with pre-prepared and maintained personal "go-kit" to
    maximize the ability to perform and maintain assigned role during
    VHA response and recovery.

-   Follow the occupant emergency procedures and assist others (VHA
    personnel, patients, visitors, etc.) as necessary to accomplish the
    directives.

-   Perform specific roles and responsibilities as assigned in the VHA
    facility's Emergency Operations Plan (EOP).

-   Follow the communication plan and reporting requirements as outlined
    in the facility's EOP and the specific Incident Action Plan for an
    emergency event.

-   Follow and enforce VHA safety rules, regulations and policies during
    emergency response and recovery.

-   Follow and enforce security measures consistent with the nature of
    the incident that has prompted the EOP activation.

-   Utilize or request (as appropriate) and integrate equipment,
    supplies and personnel for employee's specific role or functional
    area during emergency response and recovery.

-   Follow demobilization procedures that facilitate rapid transition to
    recovery operations for the healthcare facility.

-   Follow recovery procedures that ensure facility return to baseline
    activity.

9.4.2.2. [Facility Leaders Job Group]{.underline} - Includes VAMC and
VISN Directors and key operating unit managers. These individuals, due
to their everyday organizational positions, would be assigned to serve
on the Incident Management Team (ICS command and general staff
positions) during emergency response and recovery. Emergency response
and recovery competencies for this job group include:

-   Identify specific criteria of potential events that require the full
    or partial activation of the facility Emergency Operations Plan
    (EOP).

-   Activate or support activation of full or partial Emergency
    Operations Plan (EOP) for appropriate events.

-   Ensure rapid facility mobilization that transitions day-to-day
    activities into incident response organization and processes.

-   Ensure that the facility's incident management is effective,
    utilizes Emergency Operations Plan (EOP) procedures and processes,
    and uses a pro-active *management by objective* approach.

-   Manage continuous incident planning through iterative planning cycle
    procedures that provide strategic and general tactical guidance to
    facility personnel.

-   Manage efficient information processing regarding response
    activities.

-   Provide information on the facility's emergency response and
    recovery activities to patients, patient families, facility
    personnel families, media and the general public, as appropriate.

-   Monitor the response and recovery needs of the facility's functional
    areas; and, if needed, provide support with additional facilities,
    equipment, communications, personnel or other assistance.

-   Establish appropriate measures to document, track or reimburse
    financial costs associated with facility response and recovery.

-   Manage facility response so that it adheres to appropriate
    regulations and standards or seek relief as required.

-   Ensure that business continuity program considerations are
    incorporated into the facility Incident Action Planning (IAP)
    process.

-   Ensure rapid and effective demobilization of facility emergency
    response during the transition to recovery operations.

-   Ensure recovery is accomplished to restore facility to base line
    operations and to capture important lessons learned.

9.4.2.3. [Patient Care Providers Job Group]{.underline} - Includes
physicians, physician assistants, registered nurses, licensed practical
nurses, nurses working within expanded roles (RNA, RNP and others),
respiratory therapists and others who provide direct clinical patient
care. It does not include clinical support staff that provide patient
care services under the direct supervision of patient care providers
(e.g., aids and technicians). Emergency response and recovery
competencies for the patient care providers job group include:

-   Recognize situations related to patient care that indicate the need
    for full or partial activation of the healthcare facility's
    Emergency Operations Plan (EOP), and report them appropriately and
    promptly.

-   Describe patient population profiles and other situation-based
    criteria (unusual numbers, very unusual contagiousness and other
    indication of increased risk to healthcare facility personnel or
    current patients, etc.) that indicate the possible need for
    activation of the EOP.

-   Participate in the mobilization of clinical area to transition from
    day-to day operations into incident response organization and
    process.

-   Follow the healthcare occupant emergency procedures for your
    specific clinical care areas by assuring protective actions for
    patients and staff and assisting others as necessary to accomplish
    the directives.

-   Perform your clinical care duties in accordance with the facility's
    Emergency Operations Plan (EOP) and the appropriate Incident Action
    Plan (IAP) in order to support the facility's incident objectives.

-   Provide Surge [Capacity]{.underline} by managing/treating increased
    numbers of patients (compared with day-to-day activities),
    regardless of etiology.

-   Provide Surge [Capability]{.underline} by managing/treating all
    incoming patients with specialty needs that vary significantly from
    day-to-day facility activities.

-   Provide for efficient information processing for your clinical area
    through both reporting and receiving information according to
    established time schedules.

-   Manage the psychological impact on victims and victim families
    through both preventative and therapeutic measures.

-   Incorporate relevant safety practices and procedures in all incident
    operations for your clinical area.

-   Integrate outside resources into your clinical area as required to
    meet response objectives.

-   Follow demobilization procedures for your clinical area that
    facilitate rapid transition to recovery operations for the
    healthcare facility.

-   Follow recovery procedures for your clinical area that promote rapid
    return of the facility to baseline activity.

9.4.2.4. [Emergency Program Managers Job Group]{.underline} - Include
personnel primarily responsible for developing, implementing and
maintaining VHA facility emergency management programs that include the
Emergency Operations Plan. VHA Area Emergency Managers are also included
in this job group. Emergency response and recovery competencies for this
job group include:

-   Recognize circumstances and/or actions across the program manager's
    jurisdiction, if appropriate, that indicate a potential incident;
    and report the situation to facility leadership and appropriate
    authorities.

-   Provide guidance to VHA Facility Incident Managers and other
    authorities as requested on the decision to fully or partially
    activate Emergency Operations Plans (EOP).

-   Assist in the rapid mobilization of activated VHA facilities to
    transition from day-to-day activities into response and recovery
    operations.

-   Ensure full and proper execution of the appropriate VHA emergency
    operations plan (EOP) for designated VHA healthcare facilities
    during response and recovery.

-   Demonstrate the ability to function as a VHA facility's Plans Chief
    within ICS/IMS structure as indicated by the Emergency Operations
    Plan (EOP).

-   Perform or assist with the senior facility liaison function and
    ensure that relevant response and recovery information is exchanged
    with senior VHA management levels.

-   Establish (as requested by facilities) senior liaison with all
    appropriate external (non-VHA) emergency response officials in areas
    of responsibility, conduct information exchange and coordinate
    incident response strategies and tactics.

-   Participate in demobilization processes within the VHA facility and
    Veterans Integrated Service Network (VISN) to transition from VHA
    facility response to recovery operations.

-   Assist with VHA facility recovery (in appropriate area as indicated
    by your position) to full pre-incident function, including return to
    routine facility management and medical care activities.

-   Fulfill emergency management program requirements for formal
    incident After-Action Review (AAR), capture and processing of
    recommended changes, and organizational learning (by implementing
    accepted changes).

9.4.3. *Training and Exercise Program Assessment*. The following
questions can be used to assess the viability of the current training
and exercise program:

> \_\_ Does an organized awareness level training program exist for all
> employees?
>
> \_\_ Does an organized training program for all involved response
> personnel exist?
>
> \_\_ Has one individual or team been designated to coordinate this
> training?
>
> \_\_ Does the training include roles and responsibilities for each of
> the four job groups listed above?
>
> \_\_ Have training standards or criteria been established for the
> positions in the VAMC/VISN ICS organization?
>
> \_\_ Are instructors appropriately trained and certified (if
> required)?
>
> \_\_ Does the training program provide for refresher courses or some
> other method to ensure that personnel remain up-to-date in their level
> of expertise?
>
> \_\_ Have internal and external resources and organizations available
> to provide training been identified?
>
> \_\_ Is there a record-keeping system in place for the documentation
> of past training events?
>
> \_\_ Are exercises conducted in accordance with JCAHO and agency
> requirements?
>
> \_\_ Are exercise evaluations and critiques forwarded to the Emergency
> Management Committee for review, approval and actions?
>
> \_\_ Are follow-up actions and program improvement steps documented?

9.5. ***Education and Training Resources***. VHA's Employee Education
System (EES) provides emergency management education and training
programs via the VA Knowledge Network (VAKN). VAMC and VISN Education
Coordinators receive information from EES about VAKN programs, useful
web-based training programs and other resources. The EES catalog can be
accessed at:
[[http://vaww.sites.lrn.va.gov/vacatalog/]{.underline}](http://vaww.sites.lrn.va.gov/vacatalog/).

9.5.1. *Education and Training Resources for Leaders and Key Operating
Unit Managers*. Several web-based independent study courses are
available to provide an orientation to the National Incident Management
System (NIMS), as well as the National Response Plan (NRP). VHA VISN and
VAMC leadership and key operations managers should complete the
course/courses prescribed on the following matrix (Figure 9.1) to gain a
better understanding of the components of NIMS, and how to better
incorporate these concepts into Emergency Management Plans. NIMS
includes command and management (ICS), preparedness, resource
management, communications and information management, and supporting
technologies. The courses are available at no cost via FEMA's Emergency
Management Institute's virtual campus
(<http://training.fema.gov/emiweb>).

-   EMI IS-100, Introduction to Incident Command. This course provides
    an overview of the various principles of incident command, including
    operations, planning, logistics and finance.

-   EMI IS-200, Basic Incident Command for Federal Disaster Workers.
    This independent study program provides an overview of how ICS would
    function when federal workers are deployed to a disaster site, and
    what they should expect once NIMS is fully implemented at all levels
    of government.

-   EMI IS-700, National Incident Management System. Provides an
    orientation to the NIMS as it pertains to all levels of government,
    and includes segments on command and management, preparedness,
    resource management, communications and information management and
    supporting technologies.

-   EMI IS-800, National Response Plan - An Introduction. As the title
    implies, this course is designed to provide an introduction to the
    National Response Plan, and focuses on how the federal government
    will respond to a Presidentially-declared disaster.

Figure 9.1: Independent Study Courses Required

  ----------------------------------------- ------------ ------------ ------------ ------------
  **Position/Employee Group**               **IS-100**   **IS-200**   **IS-700**   **IS-800**

  VHA CO Staff with Disaster                                          X            X
  Responsibilities                                                                 

  VISN Director                                                       X            

  VISN Safety Manager/Industrial Hygienist  X            X            X            X

  Medical Center Director                                             X            X

  Medical Center Associate Director                                   X            X

  Medical Center Chief of Staff                                       X            X

  Key Operations Managers                   X                         X            

  VAMC Emergency Preparedness Coordinator   X                         X            X

  EMSHG Headquarters Staff                  X            X            X            X

  EMSHG District Managers                   X            X            X            X

  EMSHG Area Emergency Managers             X            X            X            X

  EMSHG Management Assistants                                         X            

  VHA Staff Disaster Volunteers (DEMPS)                  X            X            X

  Courses can be accessed at                                                       
  <http://training.fema.gov/emiweb>                                                
  ----------------------------------------- ------------ ------------ ------------ ------------

9.5.2. *Education and Training Programs for Patient Care Providers*.

1.  Medical Response to Weapons of Mass Destruction (WMD). In accordance
    with Section 3 of the Department of Veterans Affairs (VA) Emergency
    Preparedness Act of 2002, also known as Public Law 107-287, VA was
    directed to develop and disseminate to VA healthcare professionals a
    series of comprehensive educational and training modules on medical
    response to a potential attack with weapons of mass destruction
    (WMD)
    (<http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=107_cong_public_laws&docid=f:publ287.107.pdf>).
    As part of this effort, the Employee Education System (EES) has
    produced a series of modules intended to provide all VA and DoD
    healthcare providers, facility leadership and network leadership
    with a comprehensive resource in case of an actual incident
    involving weapons of mass destruction \[chemical, biological,
    radiological, nuclear and explosives (CBRNE)\]. Additional
    information on this training program can be found in Section 10,
    References, and at the cited web site.

2.  Veterans Health Initiative (VHI) (<http://www.va.gov/vhi>). VHI is a
    comprehensive program that recognizes the connection between certain
    health effects and military service, to allow military medical
    history to be better documented and to better prepare healthcare
    providers to better serve their veteran patients. The VHI curriculum
    includes a series of modules that can be taken either over the
    Internet or through use of a CD. Completion of the modules yields
    continuing medical education credits. The format of these modules
    (as well as the content from Veterans and Radiation, Injuries
    Associated with Biological Warfare Agents and Post-Traumatic Stress
    Disorder: Implications for Primary Care) may be adaptable to the
    Clinician training.

9.5.2.3. Other Training Resources for Care Providers.

-   Department of Defense Uniformed Services University of Health
    Sciences ([www.cdham.org](http://www.cdham.org/)). The Uniformed
    Services University of Health Sciences is the Department of
    Defense's Medical School located on the campus of the National Naval
    Medical Center in Bethesda, MD. For over twenty-five years, USUHS
    has been at the forefront of WMD training. Currently, its WMD
    education and training program includes the Graduate School of
    Nursing, three Medical Readiness Centers, the National Capital Area
    Medical Simulation Center, a Computer Aided Virtual Environment and
    Military and Emergency Medicine Department (MEM). A subordinate
    element of the MEM is the Center for Disaster and Humanitarian
    Assistance Medicine (CDHAM), whose mission includes providing
    training and education to civilian and military personnel worldwide;
    to conduct studies leading to evidence-based policies, procedures
    and educational content; and, to provide consultative and direct
    assistance to organizations involved in disaster
    response/humanitarian assistance.

-   American Medical Association National Disaster Curriculum. The Basic
    Disaster Life Support (BDLS) Provider Manual developed by the
    National Disaster Life Support Education Consortium in conjunction
    with American Medical Association (AMA). The BDSL concept utilizes
    the idea of a single basic course followed by more subject-specific
    learning units however, the members noted that the implementation of
    the BDSL concepts could be improved upon, particularly in the area
    of mental health issues and the documentation of supporting evidence
    and accompanying references.

-   The Center for Disease Control and Prevention has numerous training
    resources for public health specialists and healthcare providers.
    (See the CDC Emergency Preparedness Training Website for details
    <http://www.bt.cdc.gov/training/#ph>.)

-   The Department of Defense has a website dedicated to training
    modules, many of these are designed specifically for health care
    providers. (See the National Homeland Security Knowledgebase website
    for details <http://www.twotigersonline.com/resources.html>.)

9.5.3. *VHA Education and Training Program for Decontamination Teams*.
VHA Mass Casualty Decontamination Program
(<http://vaww1.va.gov/environagents/docs/Directive2003-045.pdf>). This
program provides policy, procedures, training and funding for supplies
and equipment for VA Medical Centers to develop and implement
decontamination capability based upon local and community needs. Focus
is placed on protection of the medical center, staff and patients in the
event of an off-site incident. The training addresses provision of
emergency care for casualties arriving at the facility following an
emergency. The training is provided by two teams located at Bay Pines,
FL, and Little Rock, AR. This train-the-trainer format offers both
awareness and operations level courses based on NFPA 472, NFPA 473 and
the Domestic Preparedness Program. This program meets all the
requirements outlined in the OSHA document: OSHA Best Practices for
Hospital Based First Receivers of Victims from Mass Casualty Incidents
Involving the Release of Hazardous Substances, December 2004
(<http://www.osha.gov/dts/osta/bestpractices/firstreceivers_hospital.html>).
The decontamination program training materials are provided on CD-ROM
and include 18 modules as follows:

1\. Awareness Level Training Modules

-   Introduction and Overview

-   Regulations and Hazard Recognition

-   Toxicology

-   Personal Protective Equipment (PPE)

2\. Operations Level Training Modules

-   Emergency Response Plan Implementation

-   Risk Assessment and Hospital Planning

-   Bioterrorism

-   Chemical Warfare Agents

-   Industrial Chemical Emergencies

-   Radiological Emergencies

-   Toxicology

-   Personal Protective Equipment (PPE)

-   Medical Cache

-   Medical Triage

-   Decontamination Area and Equipment

-   PPE - Donning/Doffing

-   Effective Presentations

-   Train-the-Trainer

9.5.4. *Education and Training Programs for Emergency Program Managers*.

9.5.4.1. Emergency Management Program Guidebook Training Resource.
Training materials for the Emergency Management Program Guidebook are
available (<http://vaww1.va.gov/EMSHG/page.cfm?pg=92>). The module
provides an understanding sufficient to be able to develop and manage an
effective all-hazards emergency management program at a VA Medical
Center or VISN office.

9.5.4.2. FEMA Emergency Management Training Courses
(<http://www.fema.gov/tab_education.shtm>). The FEMA website is
continuously updated and provides an excellent resource for ongoing
educational materials. An example is the Professional Development series
that includes seven Emergency Management Institute independent study
courses that provide a well-rounded set of fundamentals for those in the
emergency management profession. The courses are self-paced independent
studies, and each takes between 8 and 15 hours to complete.

-   IS-230 - Principles of Emergency Management. This course is designed
    to provide a basic framework of understanding of emergency
    management.

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-   IS-235 - Emergency Planning. This course is designed to prepare
    planners to use the standard terminology and concepts of a properly
    structured Emergency Operations Plan.

-   IS-242 - Effective Communication. This course is designed to improve
    your communication skills.

-   IS-241 - Decision Making and Problem Solving. This course is
    designed to improve your decision-making skills.

-   IS-240 - Leadership and Influence. This course is designed to
    improve your leadership and influence skills.

-   IS-244 - Developing and Managing Volunteers. This course is for
    emergency managers and related professionals working with all types
    of volunteers and coordinating with voluntary agencies. The course
    provides procedures and tools for building and working with
    voluntary organizations.

-   IS-139 - Exercise Design. This course is designed to develop skill
    in designing effective exercises.

Other Important Independent Study Courses:

-   IS-195 - Basic Incident Command System. As ICS gains wider use,
    there is a need to provide training for those who are not first
    responders (i.e., law enforcement, fire or emergency medical
    services personnel) who may be called upon to function in an ICS
    environment. The course includes scenarios, examples and
    opportunities for students to apply what they have learned.

-   IS-208 - State Disaster Management. This independent study course
    provides fundamental information on the disaster assistance process
    and disaster assistance programs. Individuals who serve as SCOs are
    encouraged to attend the FEMA State Coordinating Officer Course
    (E208). This independent study course must be completed before
    taking the resident course.

-   IS-275 - The EOC's Role in Community Preparedness, Response and
    Recovery Activities. This course will provide an understanding of
    the vital role an Emergency Operations Center (EOC) plays in the
    overall community's preparedness, response, and recovery activities.
    It is a prerequisite for G-275, Emergency Operations Center (EOC)
    Management and Operations.

-   IS-288 - The Role of Voluntary Agencies in Emergency Management.
    This course provides a basic understanding of the history, roles and
    services of disaster relief voluntary agencies in providing disaster
    assistance. It is appropriate for both the general public and those
    involved in emergency management operations.

-   IS-301 - Radiological Emergency Response. This course is a
    prerequisite to the resident course, S301, Radiological Emergency
    Response Operations (RERO). Its purpose is to provide a learning
    experience in which participants demonstrate a comprehensive
    understanding of radiological protection and response principles,
    guidelines and regulations to prepare them for the operations course
    (RERO). Only those approved to attend the RERO course should take
    this independent study course.

-   IS-317 - Introduction to Community Emergency Response Teams. This
    course serves as an introduction to CERT for those wanting to
    complete training or as a refresher for current team members.

-   IS-324 - Community Hurricane Preparedness. This course is designed
    to provide those involved in the decision-making process for
    hurricanes with basic information about how hurricanes form, the
    hazards posed by hurricanes, how the National Weather Service
    forecasts future hurricane behavior and what tools and principles
    can help emergency managers prepare their communities.

-   IS-346 - Orientation to Hazardous Materials for Medical Personnel.
    This course is designed to prepare hospital personnel to analyze
    hazardous materials situations, take the necessary steps to assure
    medical provider safety and identify appropriate resources for
    decontamination and medical care. However, additional training is
    required in order to diagnose and treat patients who have been
    involved in hazardous materials incidents. This course alone does
    not fulfill all of OSHA\'s requirements for hazardous materials
    training at the awareness level.

-   IS-393 - Introduction to Mitigation. This course provides an
    introduction to mitigation for those who are new to emergency
    management and/or mitigation. It is also a prerequisite for a
    non-resident Applied Practices Series course called Mitigation for
    Emergency Managers.

9.6. ***Exercise Programs***. An emergency management exercise is an
activity designed to promote emergency preparedness; test or evaluate
emergency operations plans, procedures or facilities; train personnel in
emergency management duties; and demonstrate operational capability.
Exercises consist of the performance of duties, tasks or operations very
similar to the way they would be performed in a real emergency.

9.6.1. *Purpose*. The fundamental purpose of an exercise program is to
improve operational readiness. Implementation of an effective exercise
will help facilities:

> Reveal planning weaknesses.
>
> Reveal resource gaps.
>
> Improve coordination.
>
> Clarify roles and responsibilities.
>
> Motivate officials to support the emergency program.
>
> Develop proficiency and confidence in participants.
>
> Test plans and systems in "live" situations.
>
> Foster cooperation among government agencies and private sector
> resources.

Through post-exercise assessments participants in the exercise are able
to identify how things went, and develop a list of recommendations to
the Emergency Management Committee for corrective action. This ensures
ongoing program improvement and readiness.

9.6.2. *Types of Exercises*. Exercises can be divided into five basic
categories:

-   Orientation Seminars

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-   Drills

-   Tabletop Exercises

-   Functional Exercises

-   Full-scale Exercises

9.6.2.1. Orientation Seminars. The orientation seminar is characterized
by low stress, little attention to real time, lower level of preparatory
effort, and only rough attempts to simulate reality. The focus is on
training and familiarization with roles, procedures, responsibilities
and personalities in the jurisdiction's emergency management system.
They are usually informal, in a conference room environment, and
designed to elicit constructive discussion by the participants as they
attempt to examine the jurisdiction\'s emergency management policy, and
then resolve problems based on existing emergency operations plans. The
general purpose is for participants to evaluate plans and procedures and
to resolve questions of coordination and assignment of responsibilities
in a non-threatening format and under minimum stress.

9.6.2.2. Drills. Drills are characterized by activity that tests,
develops or maintains skills in a single emergency response procedure.
The focus is limited, and drills are considered as part of necessary
ongoing training. The combination of orientation seminars and drills are
important preparatory steps for the next three exercise categories:
tabletops, functional exercises and full-scale exercises.

9.6.2.3. Tabletop Exercises. The tabletop presents a simulated emergency
situation, and is intended to evaluate plans and procedures, and to
resolve questions of coordination and assignments of responsibility.
Tabletop exercises are not concerned with time pressures, stress or
actual simulation of specific events.

9.6.2.4. Functional Exercises. Functional exercises are intended to test
or evaluate the capability of an individual function, or complex
activity with a function. It is only applicable where the activity or
function can be effectively evaluated in isolation from other emergency
management activity. An example would be an exercise of the Incident
Command System. In this example you could test and evaluate the
centralized emergency operations capability and timely response of the
Incident Management Team under a stress environment.

9.6.2.5. Full-Scale Exercise. Full-scale exercise is intended to
evaluate the overall operational capability of the emergency management
program in an interactive manner over a substantial period of time. It
involves the testing of a major portion of the basic elements existing
within emergency operations, plans and organizations in a stressful
environment.

9.6.3. *Exercise Development Process*. An exercise development program
is a commitment to incorporate progressively more challenging exercises
over a period of time. This form of long-range planning for exercises
helps bolster the essential parts of an emergency management program.
There are five general steps in developing an emergency management
exercise program. Each is described below.

9.6.3.1. Establishing the Base. Preparing an exercise involves several
tasks. To establish a firm and consistent base for your exercise, you
will need to:

-   Review the current emergency plan.

-   Conduct a needs assessment.

-   Assess your capability to conduct an exercise.

-   Define the exercise scope.

-   Select an exercise type.

-   Address costs and liabilities.

-   Develop a statement of purpose.

-   Announce the exercise.

9.6.3.2. Exercise Development. Developing an exercise involves the
following steps:

-   Identify Resources.

-   Plan the Exercise.

-   Develop Simulation Materials.

-   Prepare Facilities, Create Displays and Materials and Consider
    Exercise Logistics.

    -   Identify, Select and Train Staff.

9.6.3.3. Conducting the Exercise. Each type of exercise can be conducted
in a variety of ways, the method chosen should support the objectives
established for the event. Please refer to the FEMA Guide to Emergency
Management Exercises for more information.

9.6.3.4. Exercise Evaluation and Critique. A realistic exercise provides
the best opportunity for an organization to evaluate its emergency
operations plan. The extent and depth of the evaluation to be undertaken
is determined by the type of exercise and the objectives for the
training event.

9.6.3.5. Exercise Follow-up. Just as conducting an exercise without
doing an After-Action Report (AAR) makes the exercise incomplete, the
recommendations in an AAR without follow-up and corrective action will
keep the organization from getting the full benefit of the exercise.

9.6.3.5.1. Corrective Action Process. A Corrective Action Program (CAP)
is a process that follows an exercise or actual occurrence to identify
program shortfalls and necessary corrective actions to address those
shortfalls. The CAP begins following the AAR/discussion/critique of the
incident or exercise where deficiencies are noted that require
improvement. These can be categorized as follows:

-   Plan or standard operating procedures (SOP) revisions.

-   Training.

-   Equipment additions or modifications and facilities.

9.6.3.5.1.1. Components. There are eight components in the Corrective
Action Program, as follows:

> 1\. Develop a problem statement that states the problem and identifies
> its impact.
>
> 2\. Review the past history of corrective action issues from previous
> evaluations and identify possible solutions to the problem.
>
> 3\. Select a corrective action strategy and prioritize the actions to
> be taken.
>
> 4\. Provide authority and resources to the individual assigned to
> implementation so that the designated change can be accomplished.
>
> 5\. Identify the resources required to implement the strategy.
>
> 6\. Check on the progress of completing the corrective action.
>
> 7\. Forward problems that need to be resolved by higher authorities to
> the level of authority that can resolve the problem.
>
> 8\. Test the solution through exercising once the problem is solved.

9.6.3.5.1.2. Task Groups. A task group is assigned to each identified
area of noted deficiency to develop the necessary actions for
improvement, and a time schedule for development of the necessary
corrective action is established. The task group should do the
following:

> 1\. Develop options for appropriate corrective action.
>
> 2\. Make recommendations for a preferred option.
>
> 3\. Develop an implementation plan, which should include training.
>
> 4\. Ensure that during the next exercise the corrective action be
> evaluated to determine if the corrective actions have been successful.

9.7. ***Example Scenarios***.

9.7.1. *Flood*.

> 1\. Background - 555 bed community hospital with adjacent offices for
> ambulatory services. This hospital serves as the major healthcare
> facility for the county. It sits on the same level of the rest of the
> city structures - several feet about the level of the area's lakes and
> river running approximately one mile away through the city's main
> commercial area. Flooding of this river is a rare event.
>
> 2\. Initial Situation - During March and April, rainfall has been
> unusually heavy. The river has continued to rise. City engineers have
> stated that it's unlikely the river will crest over the banks, but
> it's possible if the rains don't stop. Weather forecast for the next
> five days calls for continued rains, but the rains are expected to be
> lighter.
>
> 3\. Initial Situation Questions/Issues Needing Resolution -
>
> a\. Should the hospital take any action at this time? If so, what?
>
> b\. Are there any specific actions the hospital should plan
> for/request from the city as precautionary?
>
> 4\. Continuing Situation - The rains continue, and the weather service
> was inaccurate. The rains have been heavy. Weather forecast now states
> that the rains should ease and end in 3 or 4 days. City engineers
> state that the river is likely to overflow the banks within the next 8
> hours. They expect the river to crest in 3 days. The National Guard
> has been called to add sand bags, but the outlook of containment is
> bleak.
>
> 5\. Continued Situation Questions and New Issues -
>
> a\. Decide to shelter-in-place or evacuate, and develop a plan to
> execute.
>
> b\. Regardless of your decision in 5a, project staff and supplies
> shortfalls that would likely occur if you stay in place, and develop
> courses of actions.
>
> c\. Plan for loss of utilities.
>
> d\. How does the hospital coordinate its planning with the city?
>
> e\. Decide if you will shelter-in-place or evacuate. Are there any
> other options?
>
> f\. Develop a plan of action to support the execution of your
> decision.

9.7.2. *VA/DoD Contingency Hospital System*.

> 1\. Background - 555-bed general medical/surgical facility -
> affiliated with medical, dental and nursing schools - provides
> tertiary support to other VAMCs in area. Military Reserve Component
> member for the hospital employees: 7% MDs; 10% RNs and LPNs; 5%
> nursing assistants; 25% respiratory technicians; 5% pharmacists; 8%
> engineering; 4% various administrative positions; 2% nursing
> assistants; 2% DDSs/dental assistants; and, 2% laboratory
> technicians/phlebotomists.
>
> 2\. Initial Situation - The US, along with NATO forces, has just
> attacked Iraq. The enemy forces have threatened to use nuclear,
> biological and chemical agents both overseas and within the United
> States. DoD is rapidly calling up the medical personnel in the Reserve
> Components. CDC has determined that a voluntary smallpox "response
> team" should be established at each hospital having in excess of 100
> beds. The original (dried calf lymph) smallpox Vaccine is available
> for these team members.
>
> 3\. Initial Questions and Issues Needing Resolution -
>
> a\. Impact of loss of staff to DoD call-up.
>
> b\. Security of facility.
>
> c\. Activation of VA/DoD Contingency Plan.
>
> d\. Training of staff to treat patients exposed to nuclear, biological
> and chemical agents.
>
> e\. Establishing smallpox response team, and instituting vaccination
> program.
>
> 4\. Information About the Continuing Situation - DoD call-ups affect
> mainly nursing and respiratory therapy. The smallpox response team has
> been established and vaccinated. The FBI states that terrorist cells
> with the US might use a chemical or biological agent. Iraq is losing
> the war and launches a massive counterattack with nerve agent (an
> organophosphate). Terrorists' attacks are occurring across the US. The
> VAMC is expecting patients - 10 post-surgical traumas, 5 psychiatric
> and 12 soldiers exposed to nerve agent and still requiring atropine to
> control symptoms. DoD tells VA to expect more casualties.
>
> 5\. Continued Situation Questions and New Issues -

a\. VAMC staffing for an extended period.

b\. Security of facility.

c\. Possible chemical and biological threat.

d\. Services for the DoD patients.

> 6\. Summary - Staffing was adequate to provided necessary care for DoD
> and veteran patients. Several bomb threats were received, but all were
> hoaxes. The long-term effects of (possible) exposure to chemical
> agents remain an ongoing problem.

9.7.3. *Mass Casualty Incident*.

> 1\. Background - 415-bed hospital providing medical, surgical,
> psychiatric and nursing home care to patients in a rural area.
>
> 2\. Initial Situation - Three miles from the hospital on Friday at
> 9:30 p.m., two school buses returning from an out-of-town activity
> collide with a cattle truck. The weather is foggy. A local farmer
> calls 911, and local law enforcement and fire rescue quickly respond.
> One bus driver and two adult chaperones are dead. The other bus
> driver, adult chaperones and truck driver are unconscious. An unknown
> number of children are injured and dead. The ambulances and local
> citizens begin transporting victims to the county hospital, which
> quickly becomes overwhelmed. The VA hospital is requested to assist.
> In the neighboring town, the children's parents are unaware of the
> accident and are anxiously waiting to meet the students at
> approximately 10:15pm.
>
> 3\. Initial Situation Questions and Issues Needing Resolution -

a\. Activation of the hospital's emergency plan.

b\. Staff and resources to care for the victims.

c\. Transportation of victims.

d\. Interface with officials from local emergency services and county
hospital.

> 4\. Information About the Continuing Situation - Conflict develops
> between the ambulance service and the hospital. The hospital is being
> overwhelmed with patients, and is not being notified if/when more
> patients will arrive. Radio and newspaper staff have arrived and want
> information. The hospital's Public Affairs Officer cannot be located.
> Recall of hospital staff is not adequate to meet the demand. The
> victims' parents are frantically trying to locate their children.
> Individuals from neighboring towns arrive at the hospital offering to
> assist in the medical care. There is conflicting information
> concerning the actual number of children involved. Due to the large
> number of dead, a temporary morgue must be established. Supplies of
> intravenous fluids, sterile 4X4 gauze and povidone iodine solution are
> critically low.
>
> 5\. Continued Situation Questions and New Issues -

a\. Use of Incident Command System.

b\. Resolution of conflict with the ambulance service.

c\. Public affairs issues.

d\. Establishment of temporary morgue.

e\. Lack of hospital staff and medical supply problems.

f\. Convergence of volunteers.

> 6\. Summary - The hospital provided care for one adult and 41
> children. Fourteen victims eventually died as a result of this
> accident. Negative media interactions were aired nationally. Class
> action litigation is pending.

9.7.4. *Hurricane*.

> 1\. Background - Hospital with a rehabilitation unit is located on a
> low-lying area of the coast.
>
> 2\. Initial Situation - The Chief of Staff (COS) is out of the
> country, and is not expected back for eight days. The Chief of
> Medicine Service has been serving as the Acting COS, but this has
> caused discord among a few physicians who also wanted to serve as
> Acting COS. Engineering Service just reported that the hospital's
> emergency power generator did not function during a test. In
> addressing budgetary constraints, several vacancies in Medical
> Administration, Environmental Management and Acquisition and Materiel
> Management Services have remained open for the past few months. The
> National Hurricane Center has been tracking a Class II hurricane that
> is steadily moving toward this hospital. It is expected to reach
> landfall in 28 hours. It is now 2:00pm on the last Friday in August.
>
> 3\. Initial Situation Questions and Issues Needing Resolution -

a\. Continuity of patient care.

b\. Decision concerning hospital evacuation.

c\. Personnel issues.

> 4\. Information About the Continuing Situation - The hurricane has
> been downgraded to Level I and is expected to reach landfall in four
> hours. Hurricane experts disagree on the potential for a significant
> storm surge. Heavy rainfall has caused some flooding in areas. The
> hospital has not experienced any significant problems with flooding,
> but some roof leaks have been reported by Nursing Service. The
> Director has received numerous calls from patients affected by
> flooding. One patient scheduled for hemodialysis has not been able to
> leave his flood-surrounded home. The Chief of Surgery Service has not
> supported decisions made by the Chief of Medicine. The Associate Chief
> Nurse and Chief Engineer have frequently voiced their support for the
> Chief Surgeon's views. Three Nursing Service employees have
> experienced diarrhea, which they feel may be related to tuna salad
> sandwiches provided to patients and staff by an outside catering
> service. Engineering Service reports that the main emergency power
> generator is still inoperative. Two 10K generators have been borrowed
> from a local National Guard Armory. The Carpenter Shop Foreman has
> stated that he does need more 4x8 sheets of plywood. During the last
> two hours, Medical Administration has reported that ten homeless
> individuals claiming to be veterans have requested shelter at the
> hospital. Some hospital employees have requested leave in order to be
> with their families. A few confrontations regarding the leave requests
> have occurred between managers and staff.
>
> 5\. Continued Situation Questions and New Issues -

a\. Continuity of patient care.

b\. Decision concerning hospital evacuation.

c\. Personnel issues.

> 6\. Summary - Patients were not evacuated from the hospital. One ward
> was closed due to the roof leaks. The facility sustained minor damage.
> The Chief of Surgery has submitted his resignation. Only two employees
> were charged AWOL for leaving the hospital. However, a grievance has
> been filed since some employees were allowed to use annual leave.
> Twenty-eight employees from other hospitals arrived to support the
> affected hospital. The diarrhea outbreak affected numerous patients
> and staff, but no long-term negative effects are expected. One of the
> homeless patients was a narcotic addict and forced his way into the
> Pharmacy. One Pharmacy Technician, who sustained head injuries trying
> to thwart the robbery, has asked for Workman's Compensation. Another
> homeless individual was the source of a pediculosis outbreak on one
> ward. The local veteran's service organizations have expressed
> displeasure over the "lack of concern for its patients."

9.7.5. *External HAZMAT Plume*.

> 1\. Background - This 167-bed hospital provides primary and secondary
> care to patients. It is located in an area that serves approximately
> 60,000 patients. Agriculture, a community college and small
> manufacturing plants are located in the area. The Emergency Program
> Coordinator is also the Safety Manager at this facility.
>
> 2\. Initial Situation - It is 10:15am on Tuesday, a beautiful spring
> morning. Today is Volunteer Appreciation Day at this hospital. The
> charcoal grills have been started, and approximately 60 volunteers
> have arrived for a cookout with the hospital's patients and staff. Two
> miles west of the hospital a train derails. Local EMS responses but
> immediately retreats due to noxious fumes. Two tankers carrying
> ammonia have ruptured. There is a four MPH wind from the southwest.
> The hospital census is 90%.
>
> 3\. Initial Situation Questions and Issues Needing Resolution -

a\. Potential impact to hospital.

b\. Protection of patients, visitors and staff.

c\. Continuity of patient care.

d\. Role of hospital in HAZMAT response.

e\. Your role as the Emergency Manager.

> 4\. Information About the Continuing Situation - The local fire chief
> served as incident commander. Individuals living/working within the
> projected plume path were ordered to evacuate at once. The community
> school and shopping mall located on the southeast side of the city was
> the evacuation shelter area for anyone unable or unwilling to move
> farther away from the incident. Forty hospital inpatients were bused
> to the shelter area. Five volunteers, one Medical Administration
> employee and three nurses supervised these evacuated patients. The
> remaining fifty-five volunteers left the hospital in their private
> automobiles. Three inpatients asked to be discharged immediately.
> Surgical procedures were ended. Patients were asked to remain in their
> rooms, and a census was conducted. A forty-year-old inpatient being
> evaluated for hypertension cannot be located. Engineering and Safety
> Services met and suggested that all cracks around doors and windows be
> sealed with tape, and the air-conditioning unit be stopped. All
> patients who had reported for outpatient clinic visits were allowed to
> either leave or remain inside the hospital. All visitors were
> encouraged to leave. If a visitor could or would not leave, they were
> allowed to stay in the cafeteria area. The EMS Director contacted the
> hospital Director and stated that she had no information concerning
> the number of victims. The local community hospital, located near the
> school, called and asked the hospital to assist with the overflow of
> victims arriving at their Emergency Room.
>
> 5\. Continued Situation Questions and New Issues -

a\. Interface with the local officials.

b\. Continuation of patient care.

c\. Protection of patients, visitors and staff.

d\. Your role.

> 6\. Summary - The ammonia leakage was finally controlled. Although the
> hospital did lie in the plume pathway, only minor odors were reported
> inside. Two railroad workers died. Five victims were treated at the
> local community hospital, and no patients were taken to the hospital.
> Evacuated patients returned. Outpatients were rescheduled. The missing
> inpatient was found in good condition; he had hidden in a bathroom and
> covered himself under a water-soaked bed sheet. One veteran patient
> who was evacuated to the shelter area experienced shortness of breath.
> Although medical records were sent with the patients, not all
> scheduled medications were obtained prior to the hasty evacuation. A
> nurse consulted the hospital and took the patient's chart into a local
> pharmacy. The prescribed inhaler was obtained, and the patient
> responded appropriately to the treatment.

9.7.6. *Bombing With Prior Threat*.

> 1\. Background - 640-bed hospital providing general medical,
> psychiatric, nursing home and rehabilitation services. There are eight
> patient care buildings located on over 150 acres.
>
> 2\. Initial Situation - After returning from break on Tuesday morning,
> the hospital Director's secretary receives a telephone call from an
> irate male. The caller states that he wants to talk to the Director.
> The secretary informs the caller that the Director is in a meeting.
> The secretary offers to listen to the caller's concerns and assist in
> resolving the problem. At this point, the caller curses and terminates
> the conversation. Although shaken and irritated, the secretary resumes
> her regular duties. Approximately ten minutes later, the man calls the
> secretary. He now informs her that he "has had tolerated too much
> mistreatment by the hospital" and he intends to "blow up the place."
> The secretary quickly opens the medical center's telephone directory
> to the Bomb Threat section. The secretary remains calm and tells the
> caller that she will be pleased to assist him if he would tell her his
> name. The caller replies Ralph, and then pauses. He again curses,
> accuses her of tricking him and terminates the call. The secretary
> calls the hospital police.
>
> 3\. Initial Situation Questions and Issues Needing Resolution -

a\. Safety of hospital patients, visitors and staff.

b\. Continuity of patient care.

c\. Preservation of hospital property.

> 4\. Information About the Continuing Situation - The Emergency
> Operations Center was activated with the hospital Director as Incident
> Commander. The hospital's Chief of Police advised the local police
> bomb squad as to the hospital's current situation. Hospital police
> initiated measures to increase security. All Service Chiefs were
> briefed. The hospital Director stated that the bomb threat was not to
> be discussed with additional staff, patients or visitors unless
> another threatening call is received. A plan to systematically search
> each building was readied. Discussions were held concerning potential
> evacuation of patients and treatment of casualties. The Associate
> Chief of Staff/Ambulatory Care requested that outpatient clinic
> schedules be canceled; the Chief of Staff denied this request.
> Wednesday morning a Library Service employee called the hospital
> Police regarding a man carrying a suitcase and entering a third floor
> shower room. This individual was reported because he "seemed to be
> sneaking around." At this time, 24 hours have passed since "Ralph's"
> initial (two) calls; he has not called again. Most employees and many
> of the patients have heard rumors concerning the bomb threat. Several
> employees used sick leave. Some patients became agitated, and five
> inpatients left the hospital against medical advice. A local radio
> station called regarding the bomb threat.
>
> 5\. Continued Situation Questions and New Issues -

a\. Continue planning for safety of individuals and hospital property.

b\. Continue patient care.

> 6\. Summary - Hospital police apprehended the individual in the shower
> room. He was a psychiatric patient who had wandered from his room. He
> was returned before the nursing unit noticed his absence. At 3:30pm,
> Wednesday, the Medical Center Director publicly announced that the
> hospital had received a bomb threat on Tuesday morning. The local
> media stated that this situation was managed poorly. Many employees
> and the local Service Organizations questioned the "secretive handling
> of this incident." This hospital never received another threatening
> call from "Ralph."

9.7.7. *Earthquake*.

> 1\. Background - This 1500-bed hospital provides medical, surgical and
> psychiatric services, and is affiliated with a large medical school.
> It is located in an area frequently impacted by earthquake activity.
> All structures on the grounds meet seismic building codes.
>
> 2\. Initial Situation - The weather forecast is dry with a daytime
> high of 80º and nighttime low of 65º. At 2:50 p.m. Wednesday, an
> earthquake measuring 5.0 in magnitude and lasting 8 seconds rattles
> the hospital. The epicenter was one mile north. Extensive damage
> occurred to elevated highways and utilities. The hospital's Emergency
> Operations Center (EOC) is activated, and the Associate Director
> served as Incident Commander. The hospital Director is in another
> state. The hospital's emergency power generator starts. It is obvious
> that the facility has sustained structural damage. Broken water pipes
> have caused water to pour through the ceilings and down the stairs.
> Debris litters the halls. All telephone lines are flooded with
> incoming and outgoing calls, as well as internal damage reports.
>
> 3\. Initial Situation Questions and Issues Needing Resolution -

a\. Accountability and safety of patients, visitors and staff.

b\. Continuity of patient care.

c\. Assessment of damage.

> 4\. Information About the Continuing Situation - Two hours after the
> initial earthquake, little information concerning the extent of damage
> to the area is known. Communications have been disrupted. Cellular and
> landline telephones have not been effective. Most information has been
> obtained from watching CNN. At this time, the damage report in the EOC
> follows:
>
> a\. There is little structural damage to the north and south wings,
> but extensive damage to the east and west wings.
>
> b\. Leakage from water, natural gas and medical gas lines has been
> contained.
>
> c\. Many electrical power lines are exposed, and the facility is using
> its emergency power system.
>
> d\. Other than the Director's Office, no Service has reported the
> status of their personnel.
>
> e\. The only information concerning the patients is that many have
> been evacuated to the front lawn area. Staff and ambulatory patients
> assisted in the evacuation process. The floor above the Surgical
> Intensive Care Unit collapsed, and it appears that there will not be
> any survivors from this area. Records indicate that there were 1213
> inpatients and approximately 300 outpatients at the time of the
> incident.

-   Approximately 100 victims from the neighborhood have walked or have
    been carried to the hospital, and request emergency medical care.
    Most injuries are lacerations and contusions. A few individuals have
    more extensive injuries.

-   The Medical Laboratory and Dental Services report that their areas
    have sustained severe damage and cannot be operational for a long
    time. Other Services report that there has been damage, but some
    Services can be restored in a day or two.

> f\. Several small fires have been reported. Employees or patients have
> used extinguishers to control all incidents.
>
> g\. Hospital Police reported that two young males forced their way
> into the Credit Union, and escaped with an undetermined amount of
> cash.
>
> h\. Nuclear Medicine and two research laboratories state that
> hazardous material contamination has occurred.
>
> i\. One patient has barricaded himself in his room, and refuses to
> leave.
>
> 5\. Continued Situation Questions and New Issues -

a\. Shelter, food and immediate/continued medical care for the patients.

b\. Humanitarian role for the general public.

> 6\. Summary - The time is 30 days after the incident, and aftershocks
> continue. The President declared the city to be a disaster area.
> Federal, state and local agencies mounted a massive response effort.
> Fourteen hospital staff and 17 patients died as a result of this
> earthquake. Patients were transported by ambulances, buses, vans and
> automobiles to surrounding hospitals. Patients that were extremely
> medically compromised were placed in the closest available medical
> facility. Two hundred thirty ambulatory patients could not be placed
> in area medical facilities until the evening following the initial
> quake. These individuals received shelter through the American Red
> Cross. Six staff, including the Chief of Psychiatric, were severely
> injured and are expected to remain off duty for at least another 30
> days. One patient remains missing. One hundred sixty local individuals
> received emergency treatment during the first 12 hours. Federal Urban
> Search and Rescue Teams feel confident that all victims have been
> extricated.
>
> The facility will remain unused until a decision is reached regarding
> demolition and repair. Social Work Service, Crisis Counseling and
> Pharmacy have mobile offices on site. Chronic medications are being
> supplied through a consolidated mail-out pharmacy vendor. Many
> patients are seeing private physicians or are inpatients in other
> hospitals through a contract agreement. The hospital staff have been
> reassigned to surrounding hospitals, since all facilities are
> operating at maximum capacity (i.e., outpatient clinics operate from
> 7:00am-12:00am and inpatient census is 100%).

Enclosures

1\. New Employee Orientation Guideline for Emergency Program Managers

2\. Example VA/DoD Exercise

3\. Example Federal/State/Local Exercise Plan

Annex A Level of Participation

Annex B Exercise Observers

Annex C Communications

Annex D Security

Annex E Public Affairs

Annex F Brief Scenario Template

4\. Example Exercise Area Diagram

5\. Tabletop Exercise Template

6\. Example Tabletop PowerPoint Template

7\. Example Exercise Critique/After Action Report

8\. FEMA's Guide to Emergency Exercises