after action report / improvement plan recovery … · after action report / improvement plan...

After Action Report / Improvement Plan Recovery Readiness Functional Exercise

Disaster Resistant Communities Group LLC – www.drc-group.com 1 | Page

After Action Report Improvement Plan

Operation POD Squad – Point of Dispensing Functional Exercise

August 20, 2013

Uncas Health District Connecticut

After Action Report Improvement Plan

Recovery Readiness - A Community Recovery Functional Exercise

June 23, 2014

Region 2 Public Health Emergency Preparedness Coalition Massachusetts



ADMINISTRATIVE HANDLING INSTRUCTIONS

1. The title of this document is The "Recovery Readiness - A Community Recovery Tabletop Exercise" After Action Report.

2. The information gathered in this AAR/IP is classified as For Official Use Only (FOUO) and should be handled as sensitive information not to be disclosed. This document should be safeguarded, handled, transmitted, and stored in accordance with appropriate security directives.

3. At a minimum, the attached materials will be disseminated only on a need-to-know basis and when unattended, will be stored in a locked container or area offering sufficient protection against theft, compromise, inadvertent access, and unauthorized disclosure.

4. Points of Contact: Health Department: Colleen Bolen City of Worcester Division of Public Health (Office) 508-799-1764 (E-Mail) [email protected] Exercise Director: Chris Floyd Disaster Resistant Communities Group LLC (Office) 850-241-3565 (E-Mail) [email protected]



CONTENTS

ADMINISTRATIVE HANDLING INSTRUCTIONS ........................................................... 2

CONTENTS .................................................................................................................... 3

EXECUTIVE SUMMARY ................................................................................................. 4

SECTION 1: EXERCISE OVERVIEW ............................................................................. 5

Exercise Details ........................................................................................................... 5

Participant Information ................................................................................................. 5

SECTION 2: EXERCISE DESIGN SUMMARY ............................................................... 7

Exercise Purpose and Design ..................................................................................... 7

Exercise Objectives, Capabilities and Activities ........................................................... 7

Scenario Summary ...................................................................................................... 7

SECTION 3: ANALYSIS OF CAPABILITIES ................................................................... 7

SECTION 4: CONCLUSION ......................................................................................... 14

APPENDIX A: IMPROVEMENT PLAN .......................................................................... 15

APPENDIX B: PARTICIPANT FEEDBACK (3 THUMBS UP – 3 THUMBS DOWN) ..... 15

APPENDIX C: ACRONYMS .......................................................................................... 21



EXECUTIVE SUMMARY

Recovery Readiness - A Community Recovery Tabletop Exercise was designed and facilitated to provide an opportunity for public health agencies along with their local community partners to collaborate in meeting the health care needs of victims while re-establishing community health systems following a hurricane.

The purpose of this report is to analyze exercise results, identify strengths to be maintained and built upon, identify potential areas for further improvement, and support development of corrective actions.

Incorporated in Section 3: Analysis of Capabilities of this After Action Report is a comprehensive listing of each Target Capability with its associated Major Strengths, Primary Areas for Improvement and Improvement Recommendations



SECTION 1: EXERCISE OVERVIEW

Exercise Details

Exercise Name: Recovery Readiness - A Community Recovery Tabletop Exercise

Type of Exercise: Tabletop

Exercise Start Date: June 23, 2014

Duration: Three Hours

Location: Worcester Massachusetts

Sponsor: Region 2 Public Health Emergency Preparedness Coalition

Purpose: The purpose of the exercise was to provide an opportunity for public health agencies along with their local community partners to collaborate in meeting the health care needs of victims while re-establishing community health systems following a hurricane.

Scenario Type: Flood

Participant Information

Participant Agency / Organization

City of Fitchburg Board of Health

City of Leominster Health Department

City of Worcester Division of Public Health

Grafton Medical Reserve Corps

Holden CERT

Leominster School District

Medical Reserve Corps

Quabbin Regional School District

Town of Athol Board of Health

Town of Auburn Board of Health



Town of Clinton Board of Health

Town of Grafton Board of Health

Town of Hopedale Board of Health

Town of Mendon Board of Health

Town of Milford Board of Health

Town of Northbridge Board of Health

Town of Northbridge Emergency Management Agency

Town of Oakham Board of Health

Town of Pepperell Board of Health

Town of Southbridge Board of Health

Town of Sterling Board of Health

Town of Sutton Board of Health

Town of Upton Board of Health

Town of Westminster Board of Health

Worcester Regional Medical Reserve Corps

Number of Participants 44



SECTION 2: EXERCISE DESIGN SUMMARY

Exercise Purpose and Design

The purpose of the exercise was to provide an opportunity for public health agencies along with their local community partners to collaborate in meeting the health care needs of victims while re-establishing community health systems following a hurricane.

Exercise Objectives, Capabilities and Activities

Capabilities-based planning allows for the exercise planning team to develop exercise objectives and observe exercise outcomes through a framework of specific action items that were derived from the Target Capabilities List (TCL). The capabilities listed below form the foundation for the organization of all objectives and observations in this exercise. Additionally, each capability is linked to several corresponding activities and tasks to provide additional detail.

Based upon the identified exercise objectives below, the exercise planning team decided to demonstrate the following capabilities during this exercise:

Community Recovery

Activity Target Capability

# 1 Initiative and Coordinate Public Health Recovery Activities

# 2 Emergency Management Coordination

# 3 Information Sharing

# 4 Mass Care

# 5 Volunteer Management

Scenario Summary

It is late July and local residents have been complacent in their hurricane preparedness activities because this year’s hurricane season has only produced several tropical storms and a few minor hurricanes, none of which have made landfall. Families are making their last minute plans for summer vacations while local business owners and government agencies are thinking that the hurricane season could be very inconsequential. However weather forecasters are predicting a major change in the atmosphere that could see a sharp increase in the severity of hurricanes within the next few weeks.



By early August area residents, business owners and government officials begin to follow the projected path of another tropical storm.

Day 1

National Hurricane Center - Tropical Storm Hanna

Advisory # 5 - Saturday – 8/3/2014 - 5:00AM

The National Hurricane Center has up-graded Tropical Depression # 1 to Tropical Storm Hanna. The storm continues its forward movement and is expected to become a hurricane in the next 12 to 24 hours.

Sustained Wind Speed Forward Movement Category

37 MPH 11 MPH Tropical Storm

The National Hurricane Center continues to monitor the storm via satellite and Hurricane Hunter planes as it continues to intensify.



SECTION 3: ANALYSIS OF CAPABILITIES

Community Recovery

Performance Target Capability

Activity # 1: Initiative and Coordinate Public Health Recovery Activities

Associated Critical Tasks

Task # 1.1: Participate with the recovery lead jurisdictional agencies (e.g., emergency management and social service) to ensure that the jurisdiction can provide health services needed to recover from a physical or mental / behavioral injury, illness or exposure sustained as a result of the incident, with particular attention to the functional needs of at-risk persons.

Adequate Evaluator # 1

Observations

The majority of participants were from small communities that indicated they had a good idea of the roles and responsibilities as it related to recovering from a hurricane.

There was some concern noted about water systems as many of the communities were on wells.

Recommendations Conduct a yearly review of roles and responsibilities for an impact of a hurricane in each individual municipality.

Task # 1.2: Notify the community via community partners of the health agency’s plans for restoration of impacted public health, medical and mental / behavioral health services.


Observations

Many participants indicated that the Massachusetts Department of Public Health would be provide most of the communication to behavioral health organizations and other licenses health care providers.

Recommendations Create relationships with providers within individual communities, where they don't exist.

Task # 1.3: Partner with public health, medical and mental / behavioral health professionals and other social networks (e.g., faith-based, volunteer



organizations, support groups, and professional organizations) from within and outside the jurisdiction, as applicable to the incident, to educate their constituents regarding applicable health interventions being recommended by public health.


Observations None

Recommendations None


Adequate Activity # 2: Emergency Management Coordination


Task # 2.1: Identify and assign qualified staff to fill the various ICS roles that are required to effectively manage public health recovery operations.


Observations

All of the participants were able to identify who might fill the appropriate Incident Command System (ICS) roles.

However, it was indicated that many of these individual did not have the full training nor is depth present to handle all of the necessary responsibilities.

Recommendations

Additional training in the ICS system would be beneficial for all participants and internal department staffs.

Consider incident management team training. Consider inter-municipal agreements to provide combined

services. Create department Continuity of Operations Plans to ensure

that the necessary policies and procedures to operate in a continuity environment.

Task # 2.2: Develop a viable Incident Action Plan identifying focusing on public health recovery operations.

Needs Improvement

Evaluator # 1

Observations There seemed to be a lack of understanding about the creation of SMART objectives.



Recommendations

Provide additional incident action planning courses, such as IS201 to all participants.

Provide an individualized training on the creation of SMART objectives.

Find a way of training new health department staff on ICS.


Adequate Activity # 3: Information Sharing


Task # 3.1: Identify intra-jurisdictional stakeholders across public health, public safety, private sector, law enforcement and other disciplines to determine information-sharing needs.


Observations None


Task # 3.2: Identify routine or incident-specific data requirements for each stakeholder.


Observations None



Adequate Activity # 4: Mass Care


Task # 4.1: Coordinate with response partners to complete a facility-specific environmental health and safety assessment of the selected shelter locations.


Observations None




Task # 4.2: Coordinate with healthcare partners to assure medical and mental / behavioral health services are accessible at or through shelter locations.

Needs Improvement

Evaluator # 1

Observations Due to the small size of some jurisdictions, they indicated that

they may have some trouble providing for all of the medical and behavioral needs of shelter residents.

Recommendations

Joint planning between all jurisdictions and the Medical Reserve Corp is needed to ensure that support will be provided, when needed.

Host a regional planning workshop to consider regional sheltering efforts.

Task # 4.3: In coordination with partner agencies, monitor facility-specific environmental health and safety, including screening for contamination (e.g., radiological, nuclear, biological, or chemical) and assure any identified deficiencies are corrected.


Observations Participants noted that shelter screening would be done by the American Red Cross staff.



Needs Improvement

Activity # 5: Volunteer Management


Task # 5.1: Support provision of initial and ongoing emergency response training for registered volunteers. Training should be supported in partnership with jurisdictional Medical Reserve Corps unit(s) and other partner groups.

Needs Improvement

Evaluator # 1



Observations

Many participants indicated that they did not have a robust volunteer program.

The Worcester Regional Medical Reserve Corps was just getting back off the ground and needed to be better incorporated.

Recommendations Consider a regional CERT program. Better understand Medical Reserve Corps capabilities and

incorporate them into planning and response efforts.

Task # 5.2: Manage spontaneous volunteers who may request to support the public health agency’s response, either through incorporating them into the response or by triaging them to other potential volunteer resources.

Needs Improvement

Evaluator # 1

Observations Many participants indicated that they would be able to provide

CORI checks through the police department but didn't have a full plan for integrating spontaneous volunteers.

Recommendations Develop a plan for spontaneous volunteer assistance.



SECTION 4: CONCLUSION

Exercises such as this one allow personnel to validate training and practice strategic and tactical prevention, protection, response and recovery capabilities in a risk-reduced environment. Exercises are the primary tool for assessing preparedness and identifying areas for improvement, while demonstrating community resolve to prepare for major incidents.

Exercises aim to help entities within the community gain objective assessments of their capabilities so that gaps, deficiencies, and vulnerabilities are addressed prior to a real incident.

Exercises are the most effective (and safer) means to:

Assess and validate policies, plans, procedures, training, equipment, assumptions, and interagency agreements;

Clarify roles and responsibilities; Improve interagency coordination and communications; Identify gaps in resources; Measure performance; and Identify opportunities for improvement.

This exercise succeeded in addressing all of the above as it provided examples of good to excellent participant knowledge, teamwork, communication and use of plans and procedures while pointing out areas in need of improvement and clarification.

Listed below is a summary of the level of performance the Target Capabilities and Tasks evaluated during the exercise. This summary outlines the areas in which exercise participants are strong as well as identifying areas that the departments should invest future planning, training and exercise funds on.

Community Recovery

Activity Target Capability Performance

# 1 Initiative and Coordinate Public Health Recovery Activities Adequate

# 2 Emergency Management Coordination Adequate

# 3 Information Sharing Adequate

# 4 Mass Care Adequate

# 5 Volunteer Management Needs

Improvement



APPENDIX A: IMPROVEMENT PLAN

This Improvement Plan has been developed specifically for exercise participants based on the results of Recovery Readiness - A Community Recovery Tabletop Exercise conducted on June 23, 2014. These recommendations draw on both the After Action Report and the After Action Conference.

Capability Observation Recommendation Responsible

Agency Completion

Date

Initiative and Coordinate Public Health Recovery Activities

The majority of participants were from small communities that indicated they had a good idea of the roles and responsibilities as it related to recovering from a hurricane.

Conduct a yearly review of roles and responsibilities for an impact of a hurricane in each individual municipality.

Many participants indicated that the Massachusetts Department of Public Health would provide most of the communication to behavioral health organizations and other licenses health care providers.

Create relationships with providers within individual communities, where they don't exist.

Emergency Management Coordination

While health departments have some staff trained in various ICS roles there is not enough trained staff to fill all the required ICS roles to effectively manage disaster recovery.

Provide ICS training to health department staff members.

Determine the feasibility of inter-municipal agreements to provide combined services.

There was a lack of understanding about the creation

Provide Incident Action Planning courses, such as IS201 to all health



of SMART objectives. departments.

Provide training on the creation of SMART objectives.

Mass Care

Due to the small size of some jurisdictions, they indicated that they may have some trouble providing for all of the medical and behavioral needs of shelter residents.

Host a regional planning workshop to consider regional sheltering efforts.

Volunteer Management

Many participants indicated that they did not have a robust volunteer program.

Explore the possibilities of working with the local United Way to enhance volunteer capabilities.



APPENDIX B: PARTICIPANT FEEDBACK (Strengths – Areas for Improvement)

Strengths

Communication both among the town employees and their partners.

Health department was ready to roll out messaging that was robust and helpful.

Continuously reviewing our plans and updating as necessary.

It was very collaborative.

It was informative.

It opened our eyes to the different towns and cities.

Excellent collaboration.

Sharing of lessons learned and varying views and approaches.

Felt a confidence in our responses and in our success in contacting NECESSARY PARTIES.

Group communicated well with common goals.

Familiar with local resources.

All input at the table was considered.

Great coordination between exercise participants. This group consisted of several different jurisdictions and input from different views was very helpful and insightful.

All participants were involved in exercise discussions. All members had both education and real world experience that added to the information discussed in exercise injects.

Exercise design made participation and input from participants beneficially effective and created an atmosphere of discussion among different jurisdictions and job positions.

Wide variety of experience levels and functional areas.

Good facilitation and team support.

The exercise provided a good situation which required an evaluation of public health responsibilities during disaster recovery operations.

There was diversity in my table group which enhanced the conversation.

Communication amongst team members.



Resourceful in finding all public partners to reach out in our community.

Well organized documentation processes in place.

The contact information - community based organizations that we coordinate with daily.

Several board of health inspectors and nurses in group.

Knowing the community resources.

Good communication between all participants.

Excellent knowledge of contact resources and community agencies.

Concise recommendations and procedure coordination.

Our group was well represented by various disciplines which contributed to a well-rounded discussion of the event.

Knowledgeable in identifying partners and contact persons to assist in event.

Able to follow basic shelter plans.

Diverse demographic of agencies were present.

It was a very interesting exercise and learning experience for a person, such as I, who has been in EMS for 30 years but not familiar with the workings of boards of health in disasters.

There was a very good exchange of information among the members of our team. Two were members of the same board of health, and four members of Medical Reserve Corps.

The facilitators of the exercise were very welcoming, organized and ran the exercise very well.

Working with other towns and other departments like the Medical Reserve Corps.

We were able to identify our partners and communicate well with them.

We determined the messages that needed to be sent, produced and distributed them.

We identified our responsibilities and time lines for achieving them.

Training was efficient.

Very knowledgeable.

Areas for Improvement

SMART goals were not specific enough and needed refining.



Not knowledgeable about reimbursement procedures.

Not enough delegation-too many assumptions.

Helping the towns and school districts to understand the importance of the exercises.

Have the EOP with us.

Inform those that need to know the importance of these events.

Though we have a plan we learned that we lack familiarity with it.

Lack of resources within the department to support the response through the event and the recovery.

Didn't notify folks about the safe use of generators.

Recommend to practice with local plans in hand.

Use of backup plans for how to deal with other events related to the storm.

Improved communication between all agencies task with responsibilities outlined in the EOP. Although this group had beneficial communications other groups may not have had as many disciplines within their group.

Increased knowledge of response plans both locally and regionally.

SMART Incident Action Plan could be more in depth from team members.

Financial system familiarity should be re-addressed.

EOP additions to include methodology should a hurricane occur.

Transportation aspect - we didn't address it enough.

Knowing the plans better.

We should have addressed the financial aspect of the disaster from the beginning.

More detailed recommendations for water contamination.

Transportation options for stranded residents.

Diverting residents to a medical shelter who required advanced medical attention.

Increased knowledge of plans and location of information.

ICS roles and who fills what position.

Financial aspect - forms needed for reimbursement, tracking of hours.



Our response plan was light on detail in keeping with SMART.

Although we all had ICS and NIMS we were not as familiar with the proper forms and documents that need to be completed for tracking purposes.

We were less prepared with backup.



APPENDIX C: ACRONYMS

Acronym Meaning

COMM Communications

CONOPS Concept of Operations

EOC Emergency Operations Center

ESF Emergency Support Function

IAP Incident Action Plan

IC Incident Command

ICS Incident Command System

IMT Incident Management Team

JIC Joint Information Center

LOFR Liaison Officer

MOA Memorandum of Agreement

MOU Memorandum of Understanding

NIMS National Incident Management System

OPS Operations

PIO Public Information Officer

SitRep Situation Report

SOG Standard Operating Guideline

SOP Standard Operating Procedure

UC Unified Command

after action report / improvement plan recovery … · after action report / improvement plan...

Documents