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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.

MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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Page 1: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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.

Page 2: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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,

Page 3: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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)

[email protected]

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)

[email protected]

Page 4: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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

Page 5: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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

Page 6: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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.

Page 7: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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

Page 8: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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.

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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.

Page 10: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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

Page 11: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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

Page 12: MRC PR Exercise Series 2015 - Home | Departamento … Report/ MRC-PR Exercise Series 2015 Improvement Plan (AAR/IP) Analysis of Core Capabilities 5 Puerto Rico Department of Health

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)