APPENDIX A: IMPROVEMENT PLAN MATRIX This Improvement Plan has been developed specifically for the Florida Department of Health Limited-Scale Drill Functional Exercise conducted on July 12, 2011. 6—Improvement Plan Matrix Capability Recommendation Corrective Action Description Capability Element Primary Agency and Point of Contact Start Date Completion Date General Ensure that all Community Reception Center (CRC) response personnel have a basic knowledge of all stations within CRC. Provide cross-training for all CRC response personnel Training TBD TBD TBD Epidemiological Surveillance and Investigation Consult the Regional Epidemiological Strike Team Coordinator when making assignments for the Epidemiological Strike Team. Before exercises or as needed, consult the Regional Epidemiological Strike Team Coordinator to determine available team members and of asset typing. Planning TBD TBD TBD Epidemiological Surveillance and Investigation Exercise treatment recommendations indicated for radiological events. Practice the treatment recommendations made during the exercise. Exercise TBD TBD TBD Epidemiological Surveillance and Investigation Compile resource lists for packaging and shipping of biological specimens. Obtain resource lists and materials appropriate for the packing and shipping of specimens (dry ice, etc.). Planning TBD TBD TBD Epidemiological Surveillance and Investigation More consistency on completing forms—staff filling out forms should sign off on the completed sections Provide participants with clear instructions on filling out forms and encourage them to sign off on the sections they complete. Planning TBD TBD TBD
On-Site Incident Management Regulate requisition requests. Look at methods to standardize requisition requests. Planning Florida RDSTF Region 5 IMT 8/1/11 8/1/12 On-Site Incident Management Investigate ways to correct confusion between multiple types of e-mail accounts and firewalls from various organizations participating on the IMT. Google docs and possibly Google position-based accounts would eliminate confusion of various types of e-mails and firewalls from various organizations. Planning/ Equipment Florida RDSTF Region 5 IMT 8/1/11 8/1/12 Disaster Behavioral Health Revise triage methods. Blue—no assessment needed; provide coping information. Green—mini-assessment and support plan. Orange—mental health assessment and referrals. User markers (only mark green and orange). Planning/ Training Florida Crisis Consortium (FCC) 8/1/11 9/1/11 Disaster Behavioral Health Obtain more interpreters for non-English speakers. Recruit additional bilingual team members. Planning FCC 8/1/11 Ongoing Disaster Behavioral Health Revise staffing matrix. Identify staffing needed (including backup team leader to build in breaks for team members). Training FCC 8/1/11 9/30/11 Disaster Behavioral Health Develop better communication between clean side and contaminated side Designate lead on each side and provide radio. Planning/ Training FCC 8/1/11 9/30/11
approach. Capabilities-based planning focuses on planning under uncertainty because the next danger or disaster can never be forecast with complete accuracy. Therefore, capabilities-based planning takes an all-hazards approach to planning and preparation that builds capabilities that can be applied to a wide variety of incidents. States and urban areas use capabilities-based planning to identify a baseline assessment of their homeland security efforts by comparing their current capabilities against the Target Capabilities List (TCL) and the critical tasks of the Universal Task List (UTL). This approach identifies gaps in current capabilities and focuses efforts on identifying and developing priority capabilities and tasks for the jurisdiction. These priority capabilities are articulated in the jurisdiction’s homeland security strategy and Multiyear Training and Exercise Plan, of which this exercise is a component. The capabilities listed here have been selected by the CDC and FDOH Limited-Scale Radiation Drill Exercise Planning Team. These capabilities provide the foundation for development of the exercise objectives and scenario. The purpose of this exercise is to measure and validate performance of these capabilities and their associated critical tasks. The selected capabilities are: Epidemiological Surveillance and Investigation Environmental Health Public Health Laboratory Testing Sample – Shipping of a sample) On-site Incident Management Exercise Objectives The Exercise Planning Team selected objectives that focus on evaluating emergency response procedures, identifying areas for improvement, and achieving a collaborative attitude. This exercise will focus on the following objectives: Epidemiological Surveillance and Investigation. Evaluate the capacity to rapidly conduct epidemiological investigations due to a deliberate exposure and evaluate disease detection, rapid implementation of active surveillance, maintenance of ongoing surveillance activities, epidemiological investigation, analysis, communicating with the public and providers about case definitions, disease risk, mitigation, and recommendations for the implementation of control measures. Environmental Health. Evaluate the capability to protect the public from environmental hazards and manage the health effects of an environmental health emergency. This capability includes the design, implementation, and interpretation of results from environmental field surveys, laboratory sample analyses, rapid needs assessments, and comprehensive environmental health and risk assessments. Public Health Laboratory Testing (Urine Sample – Shipping of a sample). Evaluate ongoing surveillance, rapid detection, confirmatory testing, data reporting, investigative support, and laboratory networking to address potential exposure, or known exposure, to all-hazards which include chemical, radiochemical, and
Epidemiological Surveillance and Investigation Relevant Exercise Objectives Direct Epidemiological Surveillance and Investigation Operations Surveillance and Detection Conduct Epidemiological Investigation Monitor Containment Direct Epidemiological Surveillance and Investigation Operations Plan Ref Task Metric Yes No Time [Name, Pg/Sec#] Identify applicable laws, policies, and implementation procedures for public health reporting and notification. [From plan]
Additional Observations: Surveillance and Detection Plan Ref Task Metric Yes No Time [Name, Pg/Sec#] Facilitate reporting consistent with disease reporting laws or regulations. [From plan] [Name, Pg/Sec#] Compile surveillance data. [From plan] [Name, Pg/Sec#] Analyze surveillance data. [From plan] [Name, Pg/Sec#] Maintain chain of custody. [From plan] [Name, Pg/Sec#] Have or have access to PHIN-compliant information systems to support detecting events of public health significance and tracking of chain of custody. [From plan] Activity Analysis Observations (Each bullet will need a completed AAR input form.) Strengths Areas for Improvement
[Name, Pg/Sec#] Have or have access to information systems that support administration of outbreak control and that comply with the PHIN functional requirements for Countermeasure and Response Administration. [From plan] [Name, Pg/Sec#] Conduct an after action debriefing (hot wash) to identify deficiencies that require corrective actions in areas such as personnel, training, equipment, and organizational structure. [From plan] Activity Analysis Observations (Each bullet will need a completed AAR input form.) Strengths for Improvement Additional Observations:
Environmental Health Relevant Exercise Objectives Direct Environmental Health Operations (Command and Control) Activate Environmental Health Direct Environmental Health Operations (Command and Control) Plan Ref Task Metric Yes No Time [Name, Pg/Sec#] Coordinate the environmental health function into response activities. [From plan] [Name, Pg/Sec#] Develop an incident-specific plan to coordinate the various elements of environmental health among Federal, State, and local response. [From plan] [Name, Pg/Sec#] Provide environmental health support and coordination for crisis and emergency risk communication (CERC). [From plan] [Name, Pg/Sec#] Identify and communicate environmental health risk issues to the affected population. [From plan] [Name, Pg/Sec#] Provide input on forecasting and planning aspects as part of the Incident Command System (ICS) for environmental health needs in the subsequent operation period. [From plan]
Additional Observations: Report Results Plan Ref Task Metric Yes No Time [Name, Pg/Sec#] Report results of CDC radionuclide testing to submitting LRN reference and chemical laboratories through the secure LRN Web site. [From plan] [Name, Pg/Sec#] Report confirmed laboratory results to all submitters in a timely manner using PHIN-compliant Laboratory Information Management Systems (LIMS). [From plan] [Name, Pg/Sec#] Notify appropriate public health, public safety, and law enforcement officials immediately (24/7) of confirmed laboratory results of a chemical, radiological or biological threat agent. [From plan] Activity Analysis Observations (Each bullet will need a completed AAR input form.) Strengths Areas for Improvement
[Name, Pg/Sec#] Develop the incident action plan (IAP) to establish priorities, procedures, and actions to be accomplished to meet the incident objectives. [From plan] [Name, Pg/Sec#] Obtain Incident Command/Unified Command approval of IAP. [From plan] [Name, Pg/Sec#] Establish operational period, not to exceed 24 hours. [From plan] Activity Analysis Observations (Each bullet will need a completed AAR input form.) Strengths Areas for Improvement Additional Observations: Execute Plan Plan Ref Task Metric Yes No Time [Name, Pg/Sec#] Disseminate IAP to other response organizations through operational briefing. [From plan] [Name, Pg/Sec#] Direct efforts to meet incident objectives in accordance with current IAP. [From plan]
[Name, Pg/Sec#] Review progress toward meeting incident objectives. [From plan] [Name, Pg/Sec#] Direct efforts to achieve personnel accountability. [From plan] [Name, Pg/Sec#] Develop mechanisms for controlling incident. [From plan] [Name, Pg/Sec#] Consider potentially affected areas. [From plan] [Name, Pg/Sec#] Update IAP based on review of resource requirements. [From plan] [Name, Pg/Sec#] Evaluate, revise, and prioritize tactics to meet incident developments. [From plan] Activity Analysis Observations (Each bullet will need a completed AAR input form.) Strengths Areas for Improvement Additional Observations:
APPENDIX H: SUMMARY OF DISASTER BEHAVIORAL HEALTH INTERVIEWEE FEEDBACK # Responses / % of Responses Strongly Agree Neither Agree Nor Disagree Disagree Strongly Disagree Not or No Answer I felt responders cared about me and my feelings. 68 19 2 — — — 77% 21% 2% — — — The support I received helped me better understand the process. 59 24 4 1 1 — 66% 27% 5% 1% 1% — The responders were warm and understanding. 68 17 4 — — — 77% 19% 5% — — — The responders body language put me at ease. 60 20 3 2 3 1 68% 23% 3% 2% 3% 1% The responders avoided the use of clichés, such as “don’t worry”; or “it’ll be Ok”; or “everything will be alright”, etc. 59 22 3 3 2 — 66% 25% 3% 3% 2% — The mental health counselors were helpful. 62 15 5 1 1 5 70% 17% 6% 1% 1% 6% The discharge process was efficient. 56 20 3 6 2 2 63% 23% 3% 7% 2% 2% I received good follow up information on how to take care of myself. 62 20 — 2 2 3 70% 23% — 2% 2% 3% I was made aware of community resources. 54 19 3 5 2 6 61% 21% 3% 6% 2% 7% If needed, I received a referral for services. 53 18 6 — 1 11 60% 20% 7% — 1% 12% My anxiety about the radiological event as I entered the was: 15 19 9 23 15 8 17% 21% 10% 26% 17% 9%
APPENDIX I: EXERCISE PARTICIPANTS’, OBSERVERS’, AND ACTORS’ FEEDBACK TOP SUCCESSES NOTED BY EXERCISE PARTICIPANTS, OBSERVERS, AND ACTORS, BY AGENCY Agency Successes Brevard County Health Department Participant Processing of victims through portals Brevard County Health Department Participant Active exercise as a group Solidify use of equipment EH Strike Team able to exercise together Environmental Health Participant Many different agencies worked together successfully Problems worked through chain of command All equipment worked well Environmental Health Participant Organized once everyone knew their tasks Crisis Consortium Evaluator Excellent cross discipline problem solving Crisis Consortium Participant Open, dedicated staff willing to learn how to make protocols work Better integration of mental health into protocols Focused attention to MH needs or population Crisis Consortium Participant Practice Good Flow Able to see bottlenecks Florida Department of Health Participant Various agencies cooperating together The capacity to learn and adapt very quickly Very knowledgeable on an emergency response Florida Department of Health Bureau of Radiation Controller Registration Participants took responsibilities very seriously work really hard to make this exercise a success Florida Department of Practice setup of CRC Concept proven and “press”
Health Evaluator EPIDEMIOLOGICAL evaluation form/tracking system merged and used together Florida Department of Health Participant Organization—ICS Onsite training Teamwork—scanner processing Florida Department of Health Evaluator Good integration and cooperation between teams, agencies, etc. Florida Department of Health to exercise incorporating behavioral health Cooperation of many agencies Clear direction Florida Department of Health Participant Ran smoothly Staffing need Florida Department of Health Participant Teamwork Safety Competence Florida Department of Health Participant Great teamwork and participation Very learning experience. Real-time web based surveillance Very awesome training and learning opportunity Florida Department of Health Bureau of Epidemiology Evaluator Coordination among players Flexibility to last minute changes Amount of Participation Florida Department of Health Bureau of Preparedness and Response Participant Using specialty strike teams from different jurisdictions to improve interoperability First time exercising CRC in Florida Department of Health Bureau of Radiation Control Evaluator Registration (EPIDEMIOLOGICAL Unit) was well organized, highly adaptable to fluid situation (Fixed problems on the spot) attention to detail in reviewing/filling out forms Personnel cross training allowed one person to float where needed Florida Proper equipment on hand
Department of Health Bureau of Radiation Control Evaluator Problems resolved quickly Florida Department of Health Bureau of Radiation Control Controller Good teamwork among participants Ability to adapt to flow of actors Florida Department of Health Bureau of Radiation Control Controller Players all worked together—great teamwork Timeline in First Aid Station seemed to work well Equipment used proficiently Florida Department of Health Bureau of Radiation Control Evaluator Participants were professional and organized Everyone appeared to be prepared Overall smooth organizational logistics Florida Department of Health Crisis Consortium Participant was ready to go Pre-Exercise precautions Lunch/BreakTime Florida Department of Health Crisis Consortium Participant Well Organized concept Knowledgeable staff Florida Department of Health Epidemiological Strike Team Participant No riot or craziness Having the CDC personnel available Collaboration with agencies Florida Department of Health Radiation Control Controller Players willingness to learn Florida Department of Teamwork by multiple disciplines Air conditioned location
Health Participant Good escort system overall Indian River County Health Department Participant Fantastic teamwork Great resource people available Leaders willing to listen Indian County Health Department Participant Liked the form Indian River County Health Department Participant Just-in-time training Organization of process Logistical support for exercise Indian River County Health Department Participant Know how to use equipment Actually exercise equipment for strike team to play together Lake County Health Department Participant Good Flow Great unit leader Staff was well trained Lake County Health Department Participant Pods were setup well Good flow Everyone helped Lake County Health Department Participant CDC and DOH EPIDEMIOLOGICAL teamwork Group participation and cooperation The correct participants were in attendance Martin County Health Department Participant Gained knowledge of CRC setup The flow and necessary staffing was tested Additional positions were found to be needed Orange County Department of Emergency Management Participant Setup was done well Organization Participants and volunteers Orange County Health Teamwork Just-in-time training
Department Participant Organization Orange County Health Department Participant Planned Well Teamwork Smooth Orange County Health Department Participant Able to use equipment and ICS structure in order to survey/monitor population and provide service Network with other agencies Practice a real life scenario and obtain onsite feedback from observers/evaluators Orange County Health Department Participant Able to use equipment Organize They had all the necessary equipment Orange County Health Department Participant People were greeted quickly The flow from greeting to screening was good Having escorts/scribes were essential Orange County Health Department Participant Data Registration Lab Federal Express delivery Orange County Health Department Participant Epidemiological Strike Team members were flexible and willing to work in any station CDC liaisons/players were helpful Orange County Health Department Participant Epidemiological team members were flexible and able to complete multiple CDC staff was very knowledgeable of infrastructure Orange Participant Initial sorting went smoothly No major breakdowns in communications Comfortable cool work area Orange of Emergency Management Participant Plenty of supplies—Masks, gloves, vests etc. Layout and setup clearly marked and ready Lunch was fabulous Regional Disaster Behavioral Health Assessment Teams (RDBHAT) People of different professional backgrounds worked well together Good attendance Participants were serious about their part in the exercise
Participant Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Cross disciplinary knowledge training Good teamwork Just-in-time training appropriate to tasks Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Cooperation between teams from different disciplines Problems encountered along the way were quickly resolved to apply what has been learned Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Very good coordination Layout/setup seemed to flow well Ability of the RDBHAT to interact with all stations Regional Disaster Behavioral Health Assessment (RDBHAT) Participant Good cooperation between multiple agency volunteers Enthusiastic role players Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Well planned and organized People stayed calm and cooperative Great group of volunteers Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Teamwork Flexibility to situational demands Professional department Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Organization overall Number of personnel Actors/Actresses Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Team members support of each other CDC online training Handouts Pre-Exercise Regional Disaster Teamwork
Behavioral Health Assessment Teams (RDBHAT) Participant Seminole County Health Department Participant Areas of confusion were discovered and corrected Seminole County Health Department Evaluator Flexibility—Teams adapted to surge and made appropriate adjustments Smooth flow—Participants seemed calm Skillful participants and utilization of tools Seminole County Health Department Participant Teamwork Safety Competence of staff State Medical Response Team 5 Participant Good number of patients through Cooperation Preplanning University of Central Florida Emergency Management Observer/Actor Everything was organized Participants were friendly Layout was functional University of Central Florida Emergency Management Observer Teamwork—Everybody working well Knowledge—Everyone seemed to what they were doing University of Central Florida Emergency Management Evaluator IMT was well organized IMT was familiar with roles and responsibilities IMT established a IAP quickly and briefed the necessary team members University of Central Florida Emergency Management Observer Operation appeared to run smoothly Appreciated tour for observers to better understand the operation Knowledgeable players University of Florida Actor Good coordination of effort Friendly, calm participants Orderly, clear plan of action
Volusia County Health Department Participant Interagency cooperation Agenda followed promptly Volusia County Health Department Participant Good Exercise to work with the radiation equipment Having some positive “Hot” people was good Working with team members was good Volusia County Health Department (MRC) Participant Sorting station was extremely successful Volusia County MRC Participant People were banded and led to the proper area Organization of the entry area Escorts were available when needed
TOP THREE AREAS FOR IMPROVEMENT NOTED BY EXERCISE PARTICIPANTS, OBSERVERS, AND ACTORS, BY AGENCY Agency Improvements Possible Solutions Brevard County Health Department Participant Wash rea None provided Brevard County Health Department Participant Wash zone clarification. Hot/cold area and enforcement of such No clear chain of command communication of needs for screeners Identify needs ahead of time Provide separate restrooms for use by those doing exercise—people kept crossing hot/cold zones People were telling others to go through wash portal monitor (non-screeners) Environmental Health Participant More scribes needed Better organization of controllers Forms need revamping—not genuine enough Forms are too specific People need to have forms with them all the way through the facility Put numbers on stickers or them on a form Environmental Health Participant No clean first-aid CRC flow was disorganized in beginning Too many bottlenecks None provided Florida Crisis Consortium Evaluator Better at one station had adverse impacts on others Recommend hand screeners for each portal Train participants to understand flow and process Change DBH triage and screening process Florida Crisis Consortium Participant Communication and flow of activities Better coordination between station/agencies Clarity of procedures Coordinate between stations, so that discharge (station 7) could add professionals to meet demand Florida Crisis Consortium Participant Comments being made by participants in front of victims when reading diagnostic sheets When reviewing sheets talk in “code” Florida Crisis Consortium Students coming and going during exercise Students meet instructors outside exercise area
Evaluator Florida Department of Health Bureau of Radiation Control Controller More behavior specialists in discharge to reduce backup Lack of 1st come, 1st serve at discharge More behavioral health specialists Use a numbering system for patient service Florida Department of Health Bureau of Radiation Control Controller More instruction for that need to be completed during exercise Became “chaotic at times” in first aid, many patients Instruction sheet specifying which forms Have designated admission person directing patients at first aid entrance Florida Department of Health Bureau of Radiation Control Evaluator Decrease bottlenecks in system (line backups) personnel roles as needed to meet backup issues Florida Department of Health Crisis Consortium Participant Lack of communication at scanner entry Lack of flow, not enough participants/clients Training/pre meeting of departments Florida Department of Health Crisis Consortium Participant Not enough discharge participants Volunteers needed more preparation information Ensure same number of discharge as registration staff Brief the volunteers Florida Department of Health EPIDEMIOLOGICAL Strike Team Participant More staff—Registrars Interpreters—Spanish to English Clipboard should stay at the front, not with client More participants from DOH Certified interpreters Identify leaders Florida Department of Health Radiation Control Controller Develop procedures for tasks to be performed More GM scanners needed for the wash area Need communication capability for the wash area Written for the wash area, and identify specific roles Provide more scanners to confirm contaminated Provide a method of communication to the station Florida Department of Better video/sound/AV briefing Audio Visual audience size
Health Participant Lunch—Better organized Layout/chair needs More staffing at first aid Box Lunches Indian River County Health Department Participant Waiting area #1 Waiting area for discharge #2 Different set up for computers #1 use handout number system #2 provide phone number for mental health Don’t make everyone wait Indian River County Health Department Discharge took too Health referrals should only be done when needed. Everyone should get a number to call None provided Indian River County Health Department Security for clean-side Escorts from to contaminated and back No clean bathroom, all were in contaminated area None provided Indian River County Health Department Participant Not and understanding of how EH strike teams function or how they are an extension of radiation control Conflicts between scanners and area unit leaders and not a chain of command Not clear what sources were needed at stations regarding screening Better understanding of station needs Better flow from first aid through screening (Change of Flow) Better Communication between stations Lake County Health Department Participant Need IT support Need interpreters Need education sheets in multiple languages Discharge area back up Have Information Technology experts onsite Lake County Health Department Participant A little more instruction as to where different sites are Faster time in shower area None provided Lake County Health Department Participant Need more escorts Escorts need to know stations and flow process Need hydration and breaks for close to work area Review flowchart and process in depth with greeters/escorts Not as many evaluators More participants
Martin County Health Department Participant Orientation of team leaders to flow responsibilities and who were making what decisions Span of control was not followed Branch manager was dictating to unit leader Better orientation of team leaders Do staffing sheet-honoring span of control More distribution of forms (earlier) Orange County Department of Emergency Management Participant Instructions and training Leadership positions and direction Use of volunteers During the training session cover all areas of the operation with unit leaders and participants Control use of volunteers through the entire drill Orange County Health Department Participant Registration tables Divide the registration tables for participants, evaluators, etc. and have signs or more signs identifying several people at each table Orange County Health Department Participant An announcement should be made indicating when drill starts More communication where we’re at during the drill None provided Orange County Health Department Participant Communication Some unable to adapt to their new temporary role at incident Multiple agencies/staff providing different instruction at such a critical time Training Orange County Health Department Participant More staff More forms Vest needs to be color coded Get more staff and more forms Depending on the station, have them use color coded vests for quick identification Orange County Health Department Communication of flow Training of station responsibilities Verbalize to entire team the desired flow/responsibilities
Participant Adherence/knowledge of job action sheets Have unit lead be sure of station responsibilities and able to train staff Give job action sheets and ensure they coincide with responsibilities assigned Orange County Health Department Participant Assignment before Discharge Things to be done Lead given a better understanding of expectations Train EPIDEMIOLOGICAL staff to appropriate area Orange County Health Department Participant Communication between exercise planners and capabilities Hydration for players More EPIDEMIOLOGICAL trained staff Train persons to fill out forms appropriately Assignments day before event like real scenario Do not send trained staff to other areas used on appropriate areas Orange County Health Department Participant Less time for participants to be onsite Provide assignment before event More EPIDEMIOLOGICAL trained staff Trained EPIDEMIOLOGICAL assigned to appropriate areas Planners should involve managers in assignments for Orange County MRC Participant Medical and Behavioral health should be delegated better Duties should be determined better based on experience and training Triage should be better deployed and actively supported by mental health Concurrent area of medical and behavioral health Designate mental health area Orange County Office of Emergency Management Participant Go over Forms and paperwork Be clear in designating span of control All stations need to be manned and ready to go when victims arrive equipment unlocked too Meet with unit leaders together so each unit understands what is happening with other units Keep recycling victims—no end for their flow
Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Need to keep exercise moving Problems with scanners Actors were not reading the back of their papers to identify behavioral health Test scanners beforehand More organization for actors Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Traffic flow/layout in the “clean area” in clean section to help people move through the stages Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Need for bilingual service providers Need for bilingual signage Redundancy of symptoms in aid area is unrealistic Provide Bilingual staff and signs Have those who have been involved in 1st aid stations design different situations Regional Disaster Behavioral Health Assessment (RDBHAT) Participant Too many patients presented with the exact same symptoms Flow within first aid not optimum Not enough staff in first aid “Name” ID stickers very hard to remove, even without gloves Vary symptomology of stress reactions Make the first aid larger i.e. Triage point and have an area for more than one “stress inoculation” More medical staffing Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Coordination between groups Clear instructions on play Too many bosses None provided Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Unclear on flow and traffic Need more understanding of layout of stations and of responsibility Long lull after initial flow of victims Victims to turn around with new sheets immediately to keep exercise moving At orientation, show a walkthrough or stations and traffic flow Regional Disaster Behavioral Health Assessment (RDBHAT) Participant Information dissemination before start of exercise One contact person (instead of CDC and others)
Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Add more behavioral assessment to first aid Clarify form usage (to whom it goes) Include more robust numbers of behavioral health with first aid to first aid and early assessment Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Clearer instructions for the wash team Provide Behavioral Health introduction for other teams More radios Increase station (online) Provide websites individuals can go to for BMH introduction Increase number of radios Regional Disaster Behavioral Health Assessment Teams (RDBHAT) Participant Layout in sequence Better communication between stations If one station responds to a surge, notify the stations downstream of impending rush Seminole County Health Department Participant Form is confusing as to when urine is collected Not all areas of form were being filled out at previous stations Develop a flow chart method Station personnel can initial or sign areas they complete Seminole County Health Department Evaluator Clarification on completed forms, section assignments, and flow Communications—Flow of participants Break in contamination control (clean and contaminated sections) Surge—Staff shortages at stations More comprehensive training on use of forms and roles Increase number of escorts to improve flow and communication Complete documentation on forms Seminole County Health Department Participant Process flow and assignments well defined (numerous change at last minute) Coaching/Instructions for actors Medical emergency protocol Better coordination/review of process flow and assignments by event planners/leaders and key players Explanation of role expectations and clear instructions for actors Publish/instruct protocol for non-radiation medical
emergencies or evaluations presenting at any station State Medical Response Team 5 Participant More info about paperwork More staff in first aid None provided University of Central Florida Emergency Management The area for discharge needs to be better organized for patients when waiting The waiting area in the discharge area should be set up better and people should be able to move faster and easier University of Central Florida Emergency Management Observer Interpreters Consider more special patients in the future None provided University of Central Florida Emergency Management Evaluator IMT IAP forms were not standardized IMT technology had issues but was adjusted More training in command vehicles to help overcome technical issues University of Central Florida Emergency Management Observer None None provided University of South Florida Actor Lack of translators Lack of clarity between green and orange stickers More translators Volusia County Health Department Participant Pre-exercise preparation More detailed instructions Pre-exercise training More clearly identify the instructions; For example: Instructions for “Hot” victims were supposed to bypass portal scan and go straight to the wash area. wasn’t a quantifiable determination of very “Hot” people, resulting in scanners sending every hot person to showers Volusia County Health Not enough escorts were available Get more volunteers
Department Participant Long periods of inactivity at the portal scanner Need to send contaminated people in the middle and beginning of the exercise, Most contaminated people came at the end of the exercise at the portal More guidance to start Send persons thru the scanner more slowly or get more actors to go thru Mix up actors that were hot Volusia County Health Department (MRC) Participant More escorts needed for sorting Need to have formal time for section meeting Separate identification for the section leader Assign more escorts Publish a time for each section to be in for a briefing and provide a section roster for unit leaders Color code the tags for unit leaders