What you need to know about emergency drills

Hospital Safety Insider, February 25, 2016

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Editor's note: This Q&A was taken from the HCPro webinar "Emergency Planning: Conducting an Effective Preparedness Exercise." Hospital security experts Christopher Sonne, CHEC, assistant director of emergency management solutions for HSS, Inc., of Denver, and his colleague, Tracy Buchman, DHA, CHPA, CHSP, national director of emergency management for HSS, discuss conducting effective emergency drills at your facility. To listen to the full program on demand, check out the HCPro Marketplace at

Q: If I have two "real-world" events, do I have to conduct exercises that year?

 Tracy Buchman: If you have two real-world events, you don't have to exercise, and I say that with a caveat that you have to make sure that in your after-action review and your improvement plan you've evaluated all six of those critical functions that are delineated out in the Joint Commission [standards] to make sure that you're evaluating your program fully. Now if you have a real-world event where you only evaluated a handful of those, then you may need to build a smaller exercise to get the evaluation of the other six critical areas that you might have not gotten. But as long as you have an influx-of-patients exercise and a second one that might be real world, then that is compliant.

Christopher Sonne: The important thing is just to make sure that the exercise is beneficial. There's a lot of organizations and even members of emergency management programs that just go through the exercises to check off the boxes for all those compliance and accreditation pieces. But even if you're going to spend a little time and a little effort, make sure it's successful. Make sure it's practical. Make sure it's truly going to benefit the organization. You know, the key is when we conduct these exercises and we look at real-world events, we want to try to identify where our true areas of opportunity are at smaller levels, during controlled environments, so we can properly address them during real-world events. That's why Joint Commission and CMS and DNV and [HFAP] have us do the exercises that we do, so we can identify our problems early before safety and lives are put [at] risk.

TB: Another thing to keep in mind is that when you're doing those construction tie-ins, those count as real-world events. If you bring your hospital incident management team together and you fill out the incident action plan for if something doesn't go as planned, this is how we're going to respond, work with your community partners and say, "This is a big event that might take out your power, one of your major utilities, and the construction team that's doing the work for you." That way you've gone through the process. You understand the scenarios. You understand the job actions sheet and the forms in a non-stressful situation. But if it does turn stressful, then you have all of that ready set in place, and often times we forget to use those opportunities to practice and to get some lessons learned.

Q: Do you have to include all six of the Joint Commission critical areas in each exercise to meet the requirements?

TB: You don't have to include them all, but at the end of the day you must [exercise] all six of those elements two times. Chris suggested an events calendar if you want to put those six items along the top and then document your real-world event, in which of those six critical areas you've evaluated for real-world events, and then make your exercises to either check them all off or to pick a few. But that way you have a grid to ensure that at the end of the day you've evaluated all six of those critical functions two times.

CS: There's a reason why The Joint Commission asks us to review those six critical areas. It's not just to make our lives difficult or to increase the paperwork. But those are critical functions of the organization that we should be evaluating and looking at. So even if you are not a Joint Commission-accredited facility, those are still six areas that we should be consistently evaluating as part of our exercise of design development.

Q: How lifelike should you make an operations-based exercise?

CS: Especially when you look at your mass-casualty incidences, your medical surge incidences, where you really want to get some additional buy-in and participation from your feedback and your medical staff, conducting and providing some good moulage can really have an impact on the overall thoughts and feelings and observations as part of the exercise. When we work with hospitals to develop exercises, we give them the option if this is something they want to look into or not, but predominantly, we've yet to have a time where someone says, "Hey, you know, we really didn't need the moulage." But what it does is it provides that additional sense of realism, that whole thing of, wow, we actually have to evaluate this patient and see what's going on. So it can help make it a bit more real to kind of increase the exercise artificiality. On the other hand, there are some exercises where making it a little too real could be just as detrimental. Active shooter and training exercises is a big area to discuss just that. It has to be in a safe environment which is going to foster and support learning, very careful on utilizing blanks or simulated firearms and ammunition during those types of exercises. Of course, we don't want anyone to get injured, but we also don't want to scare our staff.

So you have to temper both sides of, yes, we want to make it real to get their buy-in to try to elicit some real-world response that they would conduct, but we need to be careful that we're not going to scare or injure or harm because that can have the absolute opposite effect that we're looking for.

TB: I think moulage is one way to accomplish that and to make it more real life and get people to engage. There are so many videos out there to do moulage. It's really very simple. So if you have never done moulage, go out there and see if there's a simple way to add some color, if you will, for your exercise victim. The other thing that we do is we use special populations, and most often it's high school kids to do our decontamination exercises. We like to say kids are brutally honest. I have two teenage girls, and they're often brutally honest. They will tell you exactly what is wrong with your plan and where it doesn't work. And so that gives you an opportunity to fix it for kids. For example, we took the glasses away from one young lady that was going to go through the decon room. She couldn't read our signs and the other kids had to give her the instructions. You really add the reality piece to those types of exercises where you can build some chaos. You don't have the teddy bears going through on carts, and it just makes it more realistic and give you the buy-in without actually having a real event.

This is an excerpt from the monthly healthcare 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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