Exercises | Disaster Planning

The Federal Emergency Management Agency defines an exercise as “a controlled, scenario-driven, simulated experience designed to demonstrate and evaluate an organization’s capability to execute one or more assigned or implicit operational tasks or procedures as outlined in its contingency plan” (FEMA 1997).

Disaster preparedness can be tested through the response to and recovery from an actual event or through drills or exercises. An effective exercise

• includes all staff, on all shifts, for every day of the week;

• reveals existing vulnerabilities; and

• ingrains the emergency plan into the minds of the medical facility’s staff.

Although actual disasters cannot be planned, several variations of planned exercises are available. These are described below.

Orientation or information exercises. The goal of such exercises or meetings is to provide newly hired staff with an overview of the organization’s responsibilities in the event of a disaster, the methods by which these responsibilities will be discharged, and general responsibilities that they will be expected to fulfill.

Tabletop exercises. These leadership-level exercises are designed to work through interdepartmental or interorganizational issues. Typically, a scenario is presented and, at various stages, an opportunity is provided for leaders of the various functional or organizational response elements to present their concept of operation. This exercise clears up misunderstandings of responsibilities, capabilities, and methodologies and allows personnel involved to become acquainted and to collaborate prospectively—opportunities that are invaluable if an actual event were to occur.

Functional exercises. These operational-level exercises are designed to test specific functional elements of response, such as communications, decontamination procedures, and patient flow. They may involve one or more departments and typically require test actions, as opposed to discussions. Because they may interfere with normal organization operations, they are done less frequently.

Full-scale exercises. Although expensive, labor intensive, and likely to interfere with normal operations, full-scale exercises provide leaders an unequaled opportunity to see how all elements function together as well as provide valuable, realistic training for all participants. Interactions between functional elements under real-world conditions can be more easily identified in full-scale deployment than through individual functional exercises.

Exercises should be assessed against measurable information or qualitative and quantitative data gathered during the event. If your exercise reveals nothing wrong, something is wrong with your exercise. Your goal should be to stress your system to identify weaknesses. An exercise that results in no recommendations is a waste of precious time. Identified and documented deficiencies and efficiencies should highlight those plans, policies, or procedures that should be changed and the training required.

JCAHO Environment of Care standards require each accredited healthcare organization to regularly test the plan, either through actual disaster response and plan activation or in planned drills. The plan must be executed at least twice yearly. In most healthcare facilities, drills must be performed at least every four months and no more than eight months apart. This critical element of the emergency preparedness program is more than just an exercise. The more realistic the scenario, the better are the opportunities for learning and improvement.