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Rev. April 2013 HSEEP-IP01
MRC-PR Exercise Series 2015
After-Action Report/Improvement Plan
September 15, 2015
The After-Action Report/Improvement Plan (AAR/IP) aligns exercise objectives with
preparedness doctrine to include the National Preparedness Goal and related frameworks and
guidance. Exercise information required for preparedness reporting and trend analysis is
included; users are encouraged to add additional sections as needed to support their own
organizational needs.
After-Action Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP)
Exercise Overview 1 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
EXERCISE OVERVIEW
Exercise Name
Hospital to go MRC Drill 2015
Rookie of the Year MRC Drill 2015
Paint Splash Party Going Wrong MRC Drill 2015
Exercise Dates
June 19, 2015
June 23, 2015
June 27, 2015
Scope
These are a series of Operational Exercises (Drills), planned for three
different days at different locations. Capabilities of various volunteer groups
will be exercised and evaluated. Exercise play is limited to practice
volunteers’ activities during activation in different settings.
Mission Area(s) Response
Core
Capabilities Public and Private Services and Resources
Objectives
1. To evaluate the MRC volunteers knowledge on the setting up of a
mobile field hospital.
2. To evaluate and validate the mobilization, Credentials verification
and demobilization protocols of the MRC PR volunteers.
3. To evaluate the knowledge of MRC volunteers on the TRIAGE
process during an emergency.
4. To assess MRC volunteers knowledge on Decon activities.
Threat or
Hazard
Human Created:
Traffic Accident, Coliseum Collapse and Chemical Contamination with
Paint.
Scenario
The hospital is undergoing a surge due to a flu outbreak and a traffic accident
where a school bus with over 20 passengers was involved in a serious
collision. Several patients arrived to the hospital with mayor and minor
trauma. The hospital administration decided to open the mobile field
hospital to avoid contamination of those patients with flu.
During a Rock Concert having over 8,000 people, the structure of the
Coliseum collapsed. There are hundreds of people affected with trauma,
After-Action Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP)
Exercise Overview 2 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
dozens of fatalities and hundreds of frightened people after the collapse of
the structure.
A paint Splash party where the attendees are sprayed with body paint was
taking place when the people at the party started feeling bad after they were
sprayed with the paint. Some felt burning sensation of their skin and eyes,
other felt shortness of breath, blurry vision, and dizziness. Department of
health recommended establishment of a Decon Station. As the party was late
at night, few responders were available. Hundreds of persons were affected
by what appeared to be the use of the wrong type of paint.
Sponsor Office of Public Health Preparedness and Response, Puerto Rico Department
of Health.
Participating
Organizations
Puerto Rico Department of Health and volunteers from MRC-PR. Santa
Rosa Hospital from the municipality of Guayama.
Point of Contact
State POC: Jessica Cabrera Márquez, MS
Director
Office of Public Health Preparedness
and Response
Puerto Rico Department of Health
Calle Casia #2, Bo. Monacillos
San Juan, PR 00921-3200
787-773-0600 (Office)
Exercise Manager:
Héctor Colón, Ph.D.
Deputy Director
Office of Public Health Preparedness
and Response
Puerto Rico Department of Health
Calle Casia #2, Bo. Monacillos
San Juan, PR 00921-3200
787-773-0600 (Office)
After-Action Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP)
Exercise Overview 3 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
Table of Contents
Exercise Overview ........................................................................................ 1
Analysis of Core Capabilities ...................................................................... 4
Table 1. Summary of Core Capability Performance ............................................................... 4
Strengths ................................................................................................................................. 6
Areas for Improvement ........................................................................................................... 6
To evaluate and validate the mobilization, Credentials verification and
demobilization protocols of the MRC PR volunteers. .................................... 6
Strengths ................................................................................................................................. 6
Areas for Improvement ........................................................................................................... 7
To evaluate the knowledge of MRC volunteers on the TRIAGE process during an
emergency. ........................................................................................... 7
Information Sharing .................................................................................... 7
Strengths ................................................................................................................................. 7
To assess MRC volunteers knowledge on Decon activities. ................................ 7
Strengths ................................................................................................................................. 7
Areas for Improvement ........................................................................................................... 8
Conclusion .................................................................................................... 8
Appendix A: Improvement Plan ................................................................ A1
Appendix B: Exercise Participants .......................................................... B1
After-Action Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP)
Analysis of Core Capabilities 4 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
ANALYSIS OF CORE CAPABILITIES Aligning exercise objectives and core capabilities provides a consistent taxonomy for evaluation
that transcends individual exercises to support preparedness reporting and trend analysis. Table
1 includes the exercise objectives, aligned core capabilities, and performance ratings for each
core capability as observed during the exercise and determined by the evaluation team.
Objective Core
Capability
Performed without
Challenges (P)
Performed with Some Challenges
(S)
Performed with Major Challenges
(M)
Unable to be
Performed (U)
To evaluate the MRC volunteers knowledge on the setting up of a mobile field hospital.
Public and Private
Services and Resources
X
To evaluate and validate the mobilization, Credentials verification and demobilization protocols of the MRC PR volunteers.
X
To evaluate the knowledge of MRC volunteers on the TRIAGE process during an emergency.
X
To assess MRC
volunteers knowledge
on Decon activities.
X
Ratings Definitions:
Performed without Challenges (P): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws.
Performed with Some Challenges (S): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. However, opportunities to enhance effectiveness and/or efficiency were identified.
Performed with Major Challenges (M): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s), but some or all of the following were observed: demonstrated performance had a negative impact on the performance of other activities; contributed to additional health and/or safety risks for the public or for emergency workers; and/or was not conducted in accordance with applicable plans, policies, procedures, regulations, and laws.
Unable to be Performed (U): The targets and critical tasks associated with the core capability were not performed in a manner that achieved the objective(s).
Table 1. Summary of Core Capability Performance
The Medical Reserve Corps (MRC-PR) Exercise Series is a group of Operational exercises
aimed to evaluate some of the protocols developed in the Capability 15 of the Office of Public
Health Preparedness and Response of the Puerto Rico Department of Health. The series
After-Action Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP)
Analysis of Core Capabilities 5 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
consisted in three (3) Operational Exercises in which different scenarios are presented to the
group of volunteers from different areas and their response is evaluated according to the written
protocols.
In the first Drill denominated Hospital To Go Drill 2015 the scenario presented a flu outbreak
that coincides with a traffic accident. The hospital decided to open the Mobile field Hospital to
avoid cross contamination between the flu patients and the ones in the accident.
In the second scenario, a collapsed structure results from a concert in a coliseum producing
hundreds of trauma victims. MRC volunteers would use their knowledge and the training
facilitated through a resource to proceed with the TRIAGE procedures.
Finally, the third scenario involved a Paint Splash Party in with the organizers used the wrong
type of body paint causing injuries and chemical contamination to the public assisting to the
activity. The duty for the volunteers present at this exercise during the emergency is to deploy
the decontamination stations and to assist in the decontamination process.
After-Action Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP)
Analysis of Core Capabilities 6 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
To evaluate the knowledge of MRC-PR volunteers on the setting up of a mobile field hospital
The strengths and areas for improvement for each core capability aligned to this objective are
described in this section.
Strengths
The Partial capability level can be attributed to the following strengths:
Strength 1: The activity has more than enough people to set up the mobile field hospital. The
amount of people needed for the setup is six (6), while there were 8 volunteers that helped on the
setting up of the Mobile field hospitals.
Strength 2: The protocol establishes a period of two hours to complete the setup of the mobile
field hospital. The group working on that task took only one hour and 20 minutes which is way
under the time required to set the mobile field hospital up.
Areas for Improvement
The following areas require improvement to achieve the full capability level:
Area for Improvement 1: Even though a Volunteer Leader has the proper training and assumed
the roles and responsibilities to set up the mobile field hospital, the volunteers received the entire
instructions and steps on how to set up the mobile field hospital from the PRDOH personnel. It
was specified that personnel from the PR Department of Health.
Reference: Training from the OPHPR logistic section on how to assemble a Mobile field
hospital.
Analysis: In a real emergency, it is very unlikely that personnel from the PR Department of
Health will be assisting this type of operation, so the volunteers will have to establish their own
chain of command in many cases.
To evaluate and validate the mobilization, Credentials verification and demobilization protocols of the MRC PR volunteers.
Strengths
The partial capability level can be attributed to the following strengths:
Strength 1: The MRC personnel in charge of the credential protocol had the corresponding files
with all the updated information and documents of the volunteers that were going to be verified
and validated in Santa Rosa Hospital. Santa Rosa Hospital ER Director, Dr. Franz Heffelfinger
validated and received the volunteers and assigned the tasks to them.
Strength 2: Dr. Buitrago from the Santa Rosa Hospital decided that the interview with the
volunteers was not necessary since the documentation to sustain their validation was available.
Is it noteworthy to mention that the documentation presented by the personnel in charge of the
After-Action Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP)
Analysis of Core Capabilities 7 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
MRC group from the Puerto Rico Department of Health exceeded Dr. Buitrago expectations.
However, the interview would help determine that the volunteer has not changed his (her)
professional and/or personal situation in a way that could affect the operation, so, the
recommendation is to undergo the interview with the volunteers as per protocol.
Areas for Improvement
Area for Improvement 1: Dr. Heffelfinger indicated that the hospital did not have a record of
the volunteers that were working with the Hospital.
Reference: Protocol for the Request of Active Volunteers
Analysis: Dr. Heffelfinger recommended that the hospital retains a copy of the volunteer record
to have it available should another emergency require the hospital to activate volunteer
personnel. The hospital could use the MRC protocol cited in the reference as guidelines to
develop their own procedure.
To evaluate the knowledge of MRC volunteers on the TRIAGE process during an emergency.
Information Sharing
Strengths
The partial capability level can be attributed to the following strengths:
Strength 1: Participants did very well with the classification of victims. From a total of 93
victims, only 8 were misclassified (91.4% effectiveness).
Strength 2: Participants found the theoretical and practical exercises very well designed and
clarified doubts in certain types of patients that were difficult to sort.
To assess MRC volunteers knowledge on Decon activities.
Strengths
The partial capability level can be attributed to the following strengths:
Strength 1: All the volunteers went through the registration protocol which includes the
medical and psychological evaluation before stating the exercise and during the demobilization
process.
Strength 2: During the exercise a real life event occurs when a volunteer became aggressive as
he was not assigned to the task we wanted to be working with. The PRDOH Staff activated the
corresponding demobilization protocol including the intervention of the Psychologist on site.
The personnel documented the situation as per protocol.
Strength 3: A good team work environment was developed during the exercise and cooperation
within the different teams was observed.
After-Action Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP)
Analysis of Core Capabilities 8 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
Strength 4: The Decon set up was finished in approximately half hour. The Decon activities
were exercise with great realism, and the patients were visually clean after the decontamination
process.
Areas for Improvement
The following areas require improvement to achieve the full capability level:
Area for Improvement 1: Some of the personnel did not have the proper equipment during the
medical evaluation. Oxymeters were not available. An application downloaded in a few
cellphones was used instead.
Reference: Protocol for Volunteers Activation
Analysis: For this exercise the time for preparation of the exercise was limited and some of the
supplies for the exercise were not acquired with enough time. However, the use of contingency
measures provided useful for the purpose of the exercise. Shall this be a real life emergency;
other actions would have been taken. It is important to determine if the use of oxymeters were
required for the medical examination.
Area for Improvement 2: Some of the volunteers took a considerable amount of time deciding
which responder they would be helping. A safety officer was not assigned to do a visual
inspection of the level C suits.
Reference: Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving
the Release of Hazardous Substances.
Analysis: It’s important to assure that the volunteers understand their roles as established by the
leadership personnel so they know exactly what are they going to do and who the volunteer is
assigned to.
Area for Improvement 3: No supervisor was assigned to either of the two Decon Stations. No
one was escorting the patients to the Decon area. Lack of leadership was observed in this
activity.
Reference: Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving
the Release of Hazardous Substances.
Analysis: It may be advisable to assure the supervisor of the operation has a clear view of his
duties within each volunteer team to assure proper supervision of the activities.
CONCLUSION The exercises were successful with a considerable number of volunteers participating actively.
The theoretical aspect of the trainings presented resources with knowledge and the volunteers
presented a good attitude toward learning the material. Future exercises should be organized
with more time to provide for the different pre-exercise meetings and to allow for the acquisition
of all the necessary equipment and supplies.
After-Action Report/ Ebola Challenge ER Drill 2014 Improvement Plan (AAR/IP)
Appendix A: Improvement Plan A-1 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
APPENDIX A: IMPROVEMENT PLAN
This IP has been developed specifically for The Puerto Rico Department of Health as a result of Ebola Challenge ER Drill 2014
conducted on November 5 and 6, 2014.
1 Capability Elements are: Planning, Organization, Equipment, Training, or Exercise.
Core Capability Issue/Area for Improvement Corrective
Action Capability Element
1
Primary Responsible Organization
Organization POC
Start Date Completion
Date
Public and
Private
Services and
Resources
The entire instructions and
steps on the set up the
mobile field hospital came
from the PRDOH
personnel.
Retrain, refresh
Training PRDoH-MRC-PR
Mrs. Beatriz Quiñones
December 1, 2015
June. 30, 2016
Dr. Heffelfinger indicated
that the hospital did not
have a record of the
volunteer that was
working with the Hospital.
Provide a copy of the records of the resources activated in the hospital
Organization
PRDoH- MRC-PR
Mrs. Beatriz Quiñones
December 1, 2015
June. 30, 2016
Some of the personnel did
not have the proper
equipment during the
medical evaluation.
Oximeters were not
available. An application
downloaded in a few
cellphones was used
instead.
Provide the necessary material to be used at the exercise or a real life emergency
Equipment PRDoH- MRC-PR
Mrs. Beatriz Quiñones
December 1, 2015
June. 30, 2016
After-Action Report/ Ebola Challenge ER Drill 2014 Improvement Plan (AAR/IP)
Appendix A: Improvement Plan A-2 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
Some of the volunteers
took a considerable
amount of time deciding
which responder they
would be helping. A
safety officer was not
assigned to do a visual
inspection of the level B
suits.
Practice donning and doffing procedures with the PPE that will be used by the hospital.
Training PRDoH- MRC-PR
Mrs. Beatriz Quiñones
December 1, 2015
June. 30, 2016
Public and
Private
Services and
Resources
No supervisor was
assigned to either of the
two Decon Stations. No
one was escorting the
patients to the Decon area.
Lack of leadership was
observed in this activity.
Assure supervisors understand their role within the emergency to maintain accountability of their tasks.
Training PRDoH- MRC-PR
Mrs. Beatriz Quiñones
December 1, 2015
June. 30, 2016
After-Action Report/ Ebola Challenge ER Drill 2014 Improvement Plan (AAR/IP)
Appendix B: Exercise Participants B-1 Puerto Rico Department of Health FOUO
Homeland Security Exercise and Evaluation Program (HSEEP)
APPENDIX B: EXERCISE PARTICIPANTS
Participating Organizations
Federal
State
Puerto Rico Department of Health
Puerto Rico Medical Reserve Corps
Healthcare Institutions
Santa Rosa Hospital Guayama, PR
Private Institutions
Industrial Security Products (contractor)