Use your next emergency drill as a teaching tool

Hospital Safety Insider, September 10, 2015

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If you've served as a hospital safety official for any length of time, you know about the requirement for two major exercises a year that test your hospital's readiness in the event of a major incident. One of those exercises must be a live-action drill that includes a surge of patients that overwhelms your resources enough to require bringing in outside help.

It's one thing to do what the regulators require of you, but it's another thing to use the information you gather to learn something from the experience and apply the data to your future emergency planning. Here are some takeaways for performing emergency drills better in the future:

Talk things out. This is the step in your exercise process that should be taken right after the drill ends. Experts recommend doing what is called a "hot wash." Get all the major players, including hospital staff and first responders, into a room, feed them sandwiches or pizza to help them wind down (and get their minds off how hungry and tired they are), and give them a chance to talk about what happened, including what went right and what went wrong. This is a crucial step, because it allows participants to get their thoughts out while the information is fresh in their heads. If the communication protocols between emergency crews in the field and the hospital emergency rooms broke down, for instance, this is where you'll hear it first. Ideally, the hot wash should take place immediately following the end of the drill, and it shouldn't last more than an hour. Your participants have already had a long day, and their enthusiasm will wear off quickly. But make sure you're taking plenty of notes: You'll use them to figure out what mistakes were made and how to learn from them.

Write about the experience. The next thing to do is to take the information and data you've gathered and put it into some sort of written form. This way, not only do you have a formal documentation for the drill (the ever-important paper trail), but you also have a tool to work with to know where to go next. Just like you would write an incident report after any major event, the after-action report should focus on documenting the exercise, and include any analysis and opinion about what went right or wrong with protocols and recommendations for improvement.

FEMA and other government agencies will be expecting forms from the Hospital Incident Command System filled out after an actual disaster-think about the paperwork generated after 9/11 and Hurricane Katrina. These are the forms that will be used when you will seek disaster reimbursement funds from the government. As such, you should probably know where to find them and how to fill them out.

Show off a bit. One of the biggest complaints heard from safety officials in hospitals is that it's hard to get buy-in from the top, mainly because security tends to take a back seat when it comes to other more pressing budgetary items. If your CEO believes in only doing the minimum required by regulators, it might be difficult to convince him or her that there is a need for more life-like (and expensive) drills without evidence backing you up. If you have documentation from a tabletop exercise showing that your communication system might need some strengthening or your decontamination team needs some practice, that might be enough to convince the CEO to spend some money on a real-life scenario.

Also, if you did a great drill and got good feedback (positive media coverage doesn't hurt), you'll get a pat on the back and probably obtain funding for the next drill you want to hold. Own the moment, both you and your team, and get to work on an improvement plan.

If you've been walking, run a little. Maybe this was your first time running a drill, or perhaps your facility did a successful tabletop exercise. Like any other exercise, you get better by challenging yourself. So next time, use your added confidence to slip in an extra element that challenges your facility, maybe by including a surprise in the next drill. Instead of allowing your emergency managers to simply talk through the motions of what their role would be in an emergency (boring!), what would happen if the power went out all of a sudden, cutting power to the emergency radios? You might simulate the ER being flooded during a hurricane, cutting off a major access point to the facility, or a sudden surge of patients after a major accident on the local highway. These wild card simulations not only add an element of fun to your drills, but they also test your staff's ability to think on their feet, develop their own confidence, and solve problems as they occur, which is exactly what will happen in a real-life event.

Next time, dress up for the occasion
. Most safety experts say the best way to do an emergency exercise is to make it as life-like as possible, so the next step is to add some real-life scenarios, complete with collaboration with first responders and actors dressed up with moulage to simulate real wounds. This takes some expense, practice, and a good relationships with community resources, so do it a little at a time. And as always, design the drill around your weaknesses. If your staff noted a lack of experience running the decontamination procedures, for instance, maybe it's time to do an exercise with the fire department that simulates a mass casualty incident after a chemical spill to give them some practice and education.

Own up to your mistakes
. Instead of hiding from mistakes, use them as the objective of your next drill. The whole point of doing a drill is to expose the weak point in your emergency response plans. The smart safety coordinator knows they are there and uses each drill's mistakes to build the next exercise. That's the point of the improvement plan, which is written as documentation that you know what your flaws are and what will be done to work on them.

This is an excerpt from the monthly hospital safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.

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