The drill of your dreams

Hospital Safety Insider, April 28, 2016

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Holding a well-conducted drill (and using multiple types of drills) can bring you lots of good data and help steer your facility's emergency plan in a positive direction. But choose the wrong kind of drill (or do the same type all the time), and you may end up with a bunch of bored people in a room a couple times a year, or worse, someone getting hurt when something goes wrong in a poorly planned and overly aggressive scenario.

Here, we show you three major types of emergency drills used by proactive hospital safety officers, as well as some of the major pros and cons of all of them.

The tabletop drill

This is one of the most basic types of drills, and is normally used as a stepping stone-a dress rehearsal, if you will-to a live-action drill. Just as the name suggests, it usually involves a group of people sitting around a table, and it can be anything from a simple discussion about roles that would be played in an emergency to a rapidly escalating scenario with surprises built in that give participants a chance to verbally practice what they would do in response to changing situations.
If you're new to your position at the helm of hospital safety, or if your staff aren't used to participating in drills, this may be an appropriate introduction to the effort. Most healthcare workers know that drilling is a part of the job, and they want to learn. But too much too fast can also be a turnoff, and staff may become anxious or unreceptive if a large drill with lots of information is thrown at them all at once. There are also factors such as language barriers, physical ability, age, and experience to consider. Sometimes there's nothing better than a nice discussion about emergency plans over refreshments.

Familiarity with local officials. If your community has a new fire chief, or you've never done an exercise with the local police, this is a good chance for a sit-down. Whether the goal is to meet for the first time, or to stage a verbal scenario where the police (and you) practice what to do, a tabletop drill is a good way to get comfortable with first responders in your community, and most safety professionals encourage hospitals to practice as much as they can with the good guys so they can get a feel for your facility should they ever need to show up for the real thing.

Low cost. If you have a tight budget, or if you're having trouble getting management on board with the cost of a bigger drill, then the tabletop is the perfect choice for you. At most, you'll incur the cost of some copies and perhaps some donuts and coffee for your participants.

Risk of boredom.
You will be sitting around at a table, so unless your scenario is exciting, there's a good chance that participants will get restless and bored after a couple hours, especially if they are coming off a shift or have to get back to work. You may have people checking their phones for emails or messages or chatting with their neighbor. If you choose this option, make sure there are clear rules involved and ways to keep the action moving.
The live-action drill

Some experts say the best way to conduct a drill is to make it as lifelike as possible. Nothing will shake up your staff and test their response knowledge quite like a simulated fire, active shooter, evacuation, or mass casualty incident that involves real people, "gunfire," and equipment being taken out of the closets and practiced upon.

The real thing.
You want your staff to be as prepared as possible, both for things they can expect to happen and things they can't. Live-action drills are a great way to spring manageable surprises on your staff-like an onslaught of media attention from a large incident, an influx of patients dropped off at your ER door, or security concerns from admitting a criminal suspect or well-known celebrity as a patient in a mass casualty event. By being realistic, it forces your staff to think on their feet.

Educational opportunities. A realistic drill can also make for lots of teachable moments. There's nothing quite as encouraging as watching your local fire chief give an impromptu lesson to your ER staff during a hazmat disaster simulation when he realizes that not everyone knows how to operate the decontamination tent. Should they know how to do this? Yes! Will you need to test them on it later? Of course! But educational needs that unveil themselves during a drill mark the time when teaching should happen-it saves you effort, and it's also a great time to create lasting relationships with your local emergency response officials.

Fun factor.
There is nothing more boring than sitting around a conference table listening to a safety officer droning on about what your role in an emergency crisis will be, so getting up and participating in a real-life drill will be a welcome relief for your staff. On drill day, there will be an electricity in the air as they anticipate how the activity will play out. Get real actors involved, set up a response from real police officers, and dress up your victims with realistic moulage (recruit young EMS students as hysterical "victims," for example). It's an effort that will leave everyone exhausted at the end of the day, but they'll be appreciative of a different and largely fun approach.

Most costly choice.
You will spend money on a live-action drill, and you will need to get your administration on board. For some hospitals, getting a budget for large drills can be difficult. You may need to pay overtime costs of those who participate, equipment and makeup artists may cost money, and you will need to buy lunch for everyone involved.

. The downside to a realistic drill is that no matter how well you plan and keep to a script, there will always be factors out of your control. Cars will inadvertently make their way into the parking lot, a piece of equipment won't work right, or a radio won't function, leading a security guard to not realize there is a drill going on.

Risk of injuries. Another potential problem with a realistic drill is that sometimes the "make-believe" world can turn real. You need to know how to discern that and when to stop the action. If you are expecting your participants to act as if the drill is the real thing, how will they know if, say, someone really falls and breaks an arm or the excitement causes someone to have a cardiac episode? In most cases, drill coordinators build in a "hard stop" code word. Everyone involved knows this word, and if it's ever spoken, the action immediately stops to make sure everyone is okay.

The surprise drill

A drill that no one sees coming can be the ultimate test of your facility's response in an actual emergency, and in most cases you'll be pleasantly surprised at how well prepared people are. Some facilities turn real-life incidents into a drill, such as the North Carolina hospital that had a stray possum run into one of the campus building-the safety officer there turned the event into an impromptu facility intruder exercise. It's a risk-without warning and without rehearsed roles, a surprise drill can create anxiety and chaos, but it can also be a fun and useful teaching tool.

Education through real-life situations. Never underestimate the ability of real life to teach important lessons. The possum that ended up in the building at the University of North Carolina Hospitals in Chapel Hill required the setup of a command post, calling in infectious disease experts and animal control officers, and decisions had to be made about whether to shoot and tranquilize the animal or coax it out calmly. Sound a little like what might happen in an active shooter or hostage response situation?

A guaranteed solution to the problem.
When you're dealing with real life, there's no stopping the action-the possum needed to be removed from the building no matter what. Turning real-life problems into a drill forces your staff and community partners to work together to find real-world solutions. A proactive safety officer knows how to recognize a teaching opportunity and will work education into the response of a problem.

Unwelcome surprises. Pulling off a surprise drill requires level-headedness as well as respect from fellow staff and from administration, which may not look fondly upon a surprise police response disrupting the day-to-day activities at your hospital. Make sure the climate at your facility will allow for such a surprise, and keep the boss in the loop at all times.

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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