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After Action Report / Improvement Plan Healthcare Guardian Tabletop Exercise

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After Action Report Improvement Plan

Healthcare Guardian – An Active Shooter Tabletop Exercise

May 28, 2014

Consolidated New Jersey



ADMINISTRATIVE HANDLING INSTRUCTIONS

1. The title of this document is The "Healthcare Guardian - An Active Shooter 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: New Jersey South Region Healthcare Coalition: Bob Saunders Cooper University Hospital (Office) 856-968-7901 (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 ................................................................... 9

SECTION 4: CONCLUSION ......................................................................................... 17

APPENDIX A: IMPROVEMENT PLAN .......................................................................... 18

APPENDIX B: PARTICIPANT FEEDBACK (Strengths – Areas for Improvement) ........ 19

APPENDIX C: ACRONYMS .......................................................................................... 32



EXECUTIVE SUMMARY

Healthcare Guardian - An Active Shooter Tabletop Exercise was designed and facilitated as an opportunity for the management and staff that make up the region's healthcare providers to work through scenario information and injects dealing with the numerous challenges associated with responding to and managing the consequences of a shooting incident.

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 Core Capability with its associated Major Strengths, Primary Areas for Improvement and Improvement Recommendations



SECTION 1: EXERCISE OVERVIEW

Exercise Details

Exercise Name: Healthcare Guardian - An Active Shooter Tabletop Exercise

Type of Exercise: Tabletop

Exercise Start Date: May 28, 2014

Duration: Three Hours

Location: Various locations throughout Southern New Jersey

Sponsor: New Jersey South Region Healthcare Coalition

Purpose: To provide an opportunity for the management and staff that make up the region's healthcare providers to work through scenario information and injects dealing with the numerous challenges associated with responding to and managing the consequences of a shooting incident.

Scenario Type: Active Shooter

Participant Information

Participant Agency / Organizations

AtlantiCare Home Care

Bacharach Rehabilitation Hospital

CAMcare Health Corp

Cape Regional Medical Center

Cooper Health System

Cooper University Hospital

Cumberland County Health Department

Deborah Heart and Lung Center

Holy Redeemer Home Health Agency

Inspira Medical Center Bridgeton

Inspira Medical Center Elmer



Inspira Medical Center Vineland

Inspira Medical Center Woodbury

Kennedy Memorial Hospital - Stratford

Kennedy Memorial Hospital - Washington Township

Lourdes Medical Center of Burlington County

Mount Laurel EMS

Our Lady of Lourdes Medical Center

Southgate Health Care Center

Virtua Camden Hospital - SED

Virtua EMS

Virtua Marlton Hospital

Virtua Memorial Hospital - Mt Holly

Virtua Voorhees Hospital

Number of Participants 148



SECTION 2: EXERCISE DESIGN SUMMARY

Exercise Purpose and Design

The purpose of the exercise was to provide an opportunity for the management and staff that make up the region's healthcare providers to work through scenario information and injects dealing with the numerous challenges associated with responding to and managing the consequences of a shooting incident.

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 Core Capabilities List. 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:

Incident Command / Management System

Activity Core Capability

# 1 Implement Incident Command / Management

# 2 Communications

# 3 Develop Incident Action Plan (IAP)

Scenario Summary

Hospitals It is late Friday afternoon in the emergency department with the hospital's staff busily helping individuals needing medical attention. Suddenly shots ring out and the voice of an angry man can be heard shouting "Where is Dr Thomas? He is responsible for the death of my wife and he is going to pay!" The gun shoots continue to be heard as the shooter moves from room to room looking for Dr Thomas.



Long-Term Care Facilities, Community Health Centers, Home Healthcare Agencies and others It’s been an extremely challenging time at your workplace and the entire workforce has been under significant stress. The workplace has recently experienced a number of layoffs. It is late Friday afternoon when a recently terminated employee walks into the building armed with several guns and begins shooting employees and bystanders.



SECTION 3: ANALYSIS OF CAPABILITIES


Performance Core Capability

Adequate Activity # 1: Implement Incident Command / Management

Associated Critical Tasks

Task # 1.1: Staff establishes Incident Command / Management.

Adequate Holy Redeemer Home Health Agency

Observations Mobile workforce can create safety but information needs to be shared timely and effectively.

Recommendations More involvement with staff in exercises like this.

Strong Inspira Medical Center Elmer

Observations Group quickly identified that someone would need to take charge (IC) and begin delegating tasks.

Recommendations None

Adequate Inspira Medical Center Bridgeton

Observations

Bridgeton Health Center, not being and acute care facility has limited management level staffing particularly after 4:00PM.

Participants had a good knowledge of the need for ICS, however much discussion was needed to determine who would fill the positions.

Recommendations Identify an off-site Incident Command location.

Strong Inspira Medical Center Vineland

Observations Staff showed good understanding of ICS, quickly identified an

Incident Commander and began to delegate responsibilities to different staff to begin response to situation.


Strong Inspira Medical Center Woodbury

Observations Team worked well, using real-life prior experience, to forecast



recovery operations.

Recommendations Policy updates may be needed after discussions today.

Adequate Virtua Voorhees Hospital

Observations Staff established Incident Command within about 15 minutes of the incident occurring.


Strong Cooper University Hospital

Observations The Incident Command / Management Plan has been well developed.

Recommendations

Need to understand that Active Shooter incidents will not allow for movement in any of the affected areas and movement of personnel during the incident until law enforcement declares the area safe and clear.

Unless the command center is fortified by law enforcement personnel, the area is unsafe.

Strong Mount Laurel EMS

Observations Response professionals were well trained in ICS.


Strong Cooper Health System

Observations All present were able to identify the appropriate personnel within their unit and areas for an initial response.

Recommendations

All are going to review their Business Continuity Plans and ensure there is sufficient representation within their Business Continuity Teams to provide a sufficient, initial response to issues affecting their environment of care.

Task # 1.2: Initiate and implement Incident Command / Management.


Observations Staff knows what to do but will need practice in implementing plan.

Recommendations More participation in exercises like these!




Observations Early on group verbalized that they would need one person to start giving overall direction to staff.

Recommendations Need to continue to remind staff that Incident Command starts

with one person taking command, don't need to necessarily fill any or all Command / General staff early on.


Observations None



Observations Staff showed a very good understanding of HICS / ICS.


Strong Inspira Medical Center Woodbury

Observations Incident Management Team well versed in HICS.


Strong Virtua Voorhees Hospital

Observations Organizational positions were quickly identified and positions filled.

Recommendations Identify additional personnel capable of staffing positions.

Adequate Cooper University Hospital

Observations Until the incident is cleared, an Incident Command Center will need to be mobile and off-site.

Recommendations Establish alternative sites with like communications ability.

Strong Mount Laurel EMS

Observations

The group of response professionals needed a better handle on how to interact with management at the site of the event and could use additional practice with businesses to which a similar active shooter response might occur.

Recommendations Additional tabletop exercises involving a larger number of



civilian and response leaders.


Observations All present were able to identify the correct escalation and how

to initiate an Health Care System Incident Management Team response.

Recommendations

All are going to review their Emergency Preparedness Guide, Business Continuity Plan and ensure all within the unit are aware of the multiple ways to activate a System wide Incident Management Team response.


Adequate Activity # 2: Communications


Task # 2.1: A system of communicating timely and accurate information was established and maintained.


Observations Mobile workforce and health system involvement can create unnecessary delays in action.



Observations

Group quickly verbalized need to get info out to staff via overhead pages.

Also discussed internal pagers, email and swift reach messaging.

Recommendations

Need to prioritize message type sequence, what will reach most people the quickest.

Also need to address issues with how to activate some messaging systems remotely.

One area is remote access to the overhead paging system.


Observations Determined we have a very effective PIO policy and emergency notification system for staff.



Recommendations Discussed the need to establish a predetermined hotline for patient family call in.


Observations Staff verbalized multiple avenues of communicating to staff including overhead paging, swift reach system and email.

Recommendations

Need to identify where overhead page system can be accessed remotely.

Incident Command may want to send out over head page without going thru operator.

Need to see if there is a method to do so through phones in the administration offices.

Adequate Inspira Medical Center Woodbury

Observations Several communication methods are available both internally

and externally, with the ability to mass notify employees and the community.

Recommendations Process enhancements are required to allow increased use of

communication tools to include e-pigeon, social media and VOLO.


Observations PIO and liaison positions were quickly established to facilitate

good communication between involved agencies as well as staff, patients, visitors and the media.

Recommendations Developing messaging pre-crisis would facilitate getting the message out in a more expedient manner.

Adequate Cooper University Hospital

Observations

Various means of communication were discussed with the understanding that no one style should replace another.

All available communication styles should be utilized from paging systems to text messages to emails.


Adequate Mount Laurel EMS

Observations The group understood the challenge and corrective measures necessary to improve.



Recommendations Additional and more detailed tabletops.

Adequate Cooper Health System

Observations

The Unit Level Emergency Preparedness Guides and Unit Level Business Continuity Plans provide the mechanism to ensure initial communications are occurring at the unit level and throughout the effected facility.

Some roles and locales have recently changed but all were aware of the benefit of early escalation to the System wide Incident Management Team.

Recommendations

While all had varying, yet somewhat adequate capabilities of making initial, rapid notifications to building occupants most would have issues with having adequate redundancies in place and / or providing sufficient detail to occupants that may remain in hiding as the incident progressed.

Elements of the Health System ESF # 2 are investigating how we may exploit existing as well as make recommendations on acquisition of additional equipment / capabilities not yet fielded to address rapid and improved communications to all areas of the occupancies.


Adequate Activity # 3: Develop Incident Action Plan (IAP)


Task # 3.1: Establish incident objectives, priorities and operational periods.


Observations ICS will need to be set up locally as well as from the corporate level.


Adequate Inspira Medical Center Elmer

Observations Group brain stormed a lot of good information in regards to what needed to be done during the first 12 hours.

Recommendations Need formal training on writing / developing an IAP. Group knew what needed to be done however putting into

defined objectives with time periods and assignments of staff to



do need improvement.


Observations

Participants, with little prompting were able to identify and prioritize patient, visitor, family and staff needs.

Focused on immediate needs and planned for continued building operations.


Adequate Inspira Medical Center Vineland

Observations Group quickly formulated a list of tasks and staff to accomplish them during the identified operational period.

Recommendations While good at identifying tasks and who to do them the group was weak on the actual process of writing a formal IAP.

Adequate Inspira Medical Center Woodbury

Observations Incident Action Plans have always been in written format for

pre-planned events; however, real-event action plans have been in oral format.

Recommendations Using CommandAware will allow the documentation to be

placed immediately into the appropriate HICS forms memorializing the information.


Observations Positions were quickly established and assignments given. Priorities were quickly identified.

Recommendations Develop partially filled out IAP to help establish priorities pre-event.

Strong Cooper University Hospital

Observations Priority of life safety has been established and is understood to be the most important focus during an active shooter event.


Adequate Mount Laurel EMS

Observations A very good and constructive group response.





Observations

As a group incident objectives and priorities were correctly verbalized.

At the Unit / Occupancy level IAP's are expected to be verbal and the System-Wide Incident Management Team, with Unit / Occupancy representation, would be engaged for these type incidents as well as those that last longer than a single operational period.

The System-Wide Incident Management Team would provide written IAP's if and when necessary.

Recommendations

Perform a functional exercise and / or show competency via actual occurrences whereby the unit level / facility Business Continuity Team integrates with the System-Wide Incident Management Team.



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 Core Capabilities and Tasks evaluated during the exercise. This summary outlines the areas in which participants are strong as well as identifying areas that the departments should invest future planning, training and exercise funds on.


Activity Core Capability Performance

# 1 Implement Incident Command / Management Adequate

# 2 Communications Adequate

# 3 Develop Incident Action Plan (IAP) Adequate



APPENDIX A: IMPROVEMENT PLAN

This Improvement Plan has been developed specifically for exercise participants based on the results of Healthcare Guardian - An Active Shooter Tabletop Exercise conducted on May 28, 2014. These recommendations draw on both the After Action Report and the After Action Conference.

Capability Observation Recommendation Responsible

Agency Completion

Date

Implement Incident Command /

Management

Communications

Develop Incident Action Plan (IAP)



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

Strengths

Virtua Health Staff recognized the EOP and were able to articulate the plan.

Staff has trained extensively for active shooter situations.

training has occurred regularly with local law enforcement for this type of situation.

Bacharach Rehabilitation Hospital Policy was updated and reflected current guidelines.

Good understanding of ICS.

Having go bag well stocked with important information.

Holy Redeemer Home Health Agency Staff aware of possible retaliation from ADAM.

Staff knew who to contact during emergency.

Staff knew of possible communication issues and addressed accordingly.

CAMcare Health Corporation Understanding of ICS.

Knowledge of facility.

Security knowing its role.

Virtua Health Staff have all been well trained to respond to an Active Shooter incident.

Ability to lockdown facility will save lives.

Ability to share live video feed with police department.

Cooper University Hospital Subject Matter Experts participated in the exercise and were able to provide real time information and education.

A team approach was taken to participate in the exercise. This encouraged participation across disciplines.

Participation by the CEO of the health system. Demonstrated the importance and dedication to preparedness.



Kennedy Health System Teamwork of hospital staff.

Decision making of staff.

Good working relationship with external agencies.

Kennedy Health System Team collaboration.

Inspira Health Network Recent real-life event provided a wealth of experience and preknowledge about this type of event.

the Incident Management Team has a cohesive, team approach to all events, bringing a wealth of experience and knowledge as well as mutual respect for differing opinions to each event.

Exercise format allowed for detailed and comprehensive discussion on event.

Cape Regional Medical Center Tabletop presentation was logical and realistic.

Questions allowed for team interaction and communication.

Cooper University Health System Had ambulatory leader ship present; was able to put faces with names.

Videos were very informative and enlightening.

Multi disciplinary representation.

Cooper University Health System Having a variety of people from different departments.

Virtua Health Staff engaged quickly.

Staff took scenario seriously.

Staff established ICS quickly.

Cumberland County Health Department Open communication, a lot of input from each participant.

Found items that need to be added / improved upon in current plan.

Was able to walk through the current plan and how each security item that we do have could be utilized.



Cooper University Health System The training permitted interactive dialogue. Bob was able to give real life examples and involve all participants.

The training encouraged each member to consider the scenario and begin to develop a plan for implementation.

Mt Laurel Fire Department All parties in the same place for the exercise.

Discussion on active shooter topic and finding that we had consensus on many of the issues presented.

Raised questions for the future as we continue to prepare for this type of event.

Cooper University Health System The information provided was invaluable. The facilitator Robert Saunders has a wealth of information and presented the material with expertise and in a way that was easily understood by audience.

The participation was great - everyone felt comfortable with giving feedback.

The realization that we need to go back to our areas and had open dialogue with our staff so we are more prepared for any type of emergency situation.

Cooper University Hospital Good materials / examples.

Great presenter.

Helped to have content experts in the room.

Cooper University Hospital Subject experts were available.

CEO attended and committed to the hospitals success should a disaster occur.

Everyone was engaged and gave feedback.

Cooper University Health System Learning best practice for active shooter - Run, Hide, Fight. Simple process to learn and communicate to others.

Clearly defining our Incident Management Team role and how they can help ambulatory practices during any event. Better understanding for importance having accurate business continuity plan.

Attendees were engaged in conversation.



Cooper University Health System Active participation from various disciplines.

Various tools available to assess support.

Ability to ask questions as well as ones related to your area.

Cooper University Hospital Subject Matter Experts were available.

CEO attended.

All involved were fully engaged.

Mount Laurel EMS Group response and interactions to each question or circumstance as presented was excellent.

Each situation was clearly presented through the system. Again, group collaboration resulted in well thought out responses.

Through discussion and group input relating to each section, potential corrective actions were discussed by the group. Follow-up discussion resulted in continued discussion and the identification of weaknesses and strengths, as well as, specific actions and additional response personnel that should be brought in at a future date to refine response strategies and plans.

Cooper University Hospital Excellent representation from several areas of hospital, including administration.

Ample SMEs in attendance.

Very engaging exercise and all participants engaged!

Inspira Medical Center Woodbury Team worked well together.

Policy revision will need to be completed.

Positive for gap analysis.

Cape Regional Medical Center Group participation.

Strategic site awareness - planning.

Cumberland County Health Department A plan of action is in place.

The exercise alerted us on what needs to be improved.



The exercise shows our strengths and weaknesses.

Cumberland County Health Department Everyone was actively participating and brainstorming about the possibility of a real attack as we had a shooting about four blocks away from our job a few weeks ago. The plan was assessed and some things were brought up that not everyone knew about and information was shared.

Everyone agreed that some things could be tweaked to possibly make the aftermath smoother and determining who would step in should supervisors either be absent or hurt.

Learned some actions to take such as keeping hands out and fingers apart when police arrive.

Cooper Health System Gave important information if this ever were to happen.

Who to call and where to go.

How to react

Cumberland County Health Department Made you think how you would react to the situation.

Brought up the subject, which is not usually discussed, realized how our paging system worked if there was time to react.

We are planning a rehearsal drill as part of our staff meeting.

Cooper Health System Interaction with others in the group very useful.

Speaker was great with what actions should take place when in similar situations.

Now know who and when to contact when in distress.

Cumberland County Health Department Evaluating EAP in comparison to Active Shooter incident.

Examining management response to incident.

Finding any gaps / corrections in EAP.

Cooper University Hospital The method of completing the exercise as a group was useful as we had a mixed group of participants...people from all levels.

Having members of the IMT present to reinforce what we, as an organization, already



do.

Having all levels of employees present to get multiple perspectives.

Cumberland County Health Department We were able to have representatives from all divisions as well as senior management participate in the exercise.

We were able to utilize current Safety Plans and also incorporate suggestions / ideas from the group to update plan.

The exercise allowed staff to actively begin thinking about next steps in reference to an active shooter incident.

Cumberland County Health Department Everyone was in agreement the scenario could occur in our own health department. Every department was represented to participate in this drill. The facilitator kept the group on task.

Positive feedback received from mostly everyone on the "areas of improvement" by brainstorming. This helped us to discover important aspects that were missing from our plan.

Health officer and two other individuals who are involved with bioterrorism, emergency preparedness and disaster planning were very informed of disaster response policy.

Cumberland County Health Department Plan is being developed.

Opened conversation up to new ideas for security.

Plan being developed does include most of what was discussed.

Virtua EMS Worked well as a team, all were able to provide input and come to agreements thru discussion on actions.

Knew where to access policies and information through companies computer system.

Eventual realization that both business and medical side of incident would need to be managed.

Virtua EMS Good understanding of what to do in the first 10 minutes (run/hide/fight).

Lively discussion between all participants during exercise. No one took on a "I know better" approach. All opinions were considered.

Once the expectation of our roles were understood by all, the scribing of ideas became



a good tool for planning and answering the questions.

Cape Regional Medical Center The scenario was very realistic therefore provided a good exercise; our Active Shooter policy is new so it was good that we used it as a guide when responding to the questions

We invited the right individuals to play-out the exercise.

Good discussion / debate throughout the exercise.

Cooper Health System Representation of "Satellite" offices leadership was present and actively participated.

Multiple disciplines and office types participated and provided input.

The environment allowed both "seasoned veterans" and those new to their positions share opinion, insight, have questions answered and participate as equals.

Cumberland County Health Department Engaging with other staff for help in the different scenarios.

Finding out how different scenarios will play out differently in other coworkers' thoughts.

Working together as a team to find solutions.

Cooper University Hospital Facilitator was excellent!

Multiple department leaders present.

Presentation was interesting and kept my attention.

Cooper Health System Effectively able to respond to an active shooter incident.

Understanding the Incident Command System in regards to the response.

Cumberland County Health Department Group communication.

Identified weakness in the department's emergency planning.

Identified need for additional ICS training.

Areas for Improvement

Virtua Health Constantly updating the recall list for assistance.



Continued education and refreshing an understanding of Incident Command.

Constant drilling of the staff for responding to these incidents.

Bacharach Rehabilitation Hospital EOP should be reference in code silver policy.

Holy Redeemer Home Health Agency More participation in exercises like these!

CAMcare Health Corporation More accurate accounting of employees, visitors and patients.

Knowing when to shelter in-place versus evacuate.

Control of people entering facility.

Virtua Health Need more detailed recovery plan for Code Triage or Active Shooter response.

Need to develop idea of Family Assistance Centers.

Need to develop policy mandating CISD after critical events.

Cooper University Hospital Increased involvement in preparedness education.

Communication across the organization: departments at the hospital don't hear the overhead message, protected / shielded areas don't receive cellular coverage, external buildings and offices are not connected to the hospital systems.

Address / correct the mentality of "this couldn't happen to me".

Kennedy Health System Communication of staff.

Recognition of threat.

Decision to evacuate / hide out based on proximity to shooter.

Kennedy Health System Communication over the course of the incident.

Inspira Health Network Based on discussion, existing policy will need re-work.

Encourage a facilitated discussion with staff about a potential episode.

Consider the need for a network approach to such instances.



Cape Regional Medical Center Educating staff on our Code Silver policy.

Clarify with the county's Office of Emergency Management how they could assist with diversion.

Cooper University Health System Revise the trifold.

Reinforce and re-educate on the intent of the Business Continuity Plan.

Cooper University Health System Would like more specific steps when dealing with a hostile situation, perhaps going over a mock emergency preparedness and / or business continuity plan and giving feedback on what should be in such plans.

Virtua Health Some pre-crisis messaging should be developed to expedite developing communications to staff, patients, visitors and the media.

Train more staff to fill ICS roles.

Develop plan for Family Assistance Center.

Cumberland County Health Department Improve upon the current panic button that alerts local police department by adding an alarm that alerts the rest of the health department.

Moving the "paging" button on our phones to the first screen.

Fixing the lock on Environmental Division's door.

Cooper University Health System The training should be implemented system wide. All employees should become involved and given the opportunity to express their viewpoints and prepare themselves for an emergency situation.

The emergency trifold needs to be updated.

Mt Laurel Fire Department Figuring out how to handle the large amount of people evacuating.

Discussion on altering evacuation plans.

Cooper University Health System Information needs to be presented on a wider scale - there were only 1-2 members of certain departments in attendance.

There needs to be more of these type of sessions to keep the focus present in our



minds.

We'd like to see more specific information as it relates to smaller satellite offices with no security presence.

Cooper University Hospital Make exercise participation mandatory.

Cooper University Hospital Better attendance.

Identify a safe place and ensure everyone is aware.

Communication.

Cooper University Health System Specific ambulatory training for practices. Onsite training for larger facilities.

Practices need to review Emergency Preparedness Guide AKA "trifold" to ensure applicable information is accurate for their location.

Reviewing business continuity plan. Ensuring everyone has copy on site and has knowledge of plan.

Cooper University Health System Review and revise the business continuity plan.

Revise "trifold".

Healthcare scenarios related to our satellite offices.

Cooper University Hospital Attendance was low.

We need to work on a better communication plan.

All areas need to make sure that staff is aware of their area's disaster planning.

Mount Laurel EMS Clearer planning and clearer response guidelines.

Coordination and communications.

Greater workplace interaction with businesses and organizations - additional tabletop exercises.

Cooper University Hospital Better communication to front line staff on policy and procedures relating to this topic, correct number to call ("0" vs. 2400 vs 911).



Hospitals operators should be included in training on this process as well.

Heightened awareness of importance of reporting suspicious behaviors.

Inspira Medical Center Woodbury More of these types of exercises, with differing topics.

Cape Regional Medical Center Policy procedures review.

Department awareness meetings.

Cumberland County Health Department Our communication system with all employees needs to be addressed.

Clear evacuation routes need to be posted.

Drills need to be done with local agencies.

Cumberland County Health Department Having layout of building more accessible. Management was very supportive and willing to consider suggestions by staff.

Finding alternative storage areas to de-clutter as building is small.

Possibly putting in cameras or locking doors with speaker outside of building for visitors to identify themselves.

Cooper Health System Update tri-fold.

Cumberland County Health Department I am the first to greet people, besides trying to hit alarm, not sure how to defuse the situation.

Realized alarm button should be moved to a better location.

Making sure exit doors are marked and escape ladders are in place.

Cooper Health System Update office materials for contacts.

Cumberland County Health Department We need to hold drills much like schools hold fire drills in order to focus employees mind on what to do in an emergency.

Attach to the "panic button" (which sounds at the police station), an alarm that sounds in the building when a potentially dangerous individual enters in a threatening manner.

10-12 employees sat in on this exercise; the rest of employees need to have the



shorter, general training on How to Respond to an Active Shooter for better preparation.

Cooper University Hospital More participants, from a more diverse cross-section of employees.

This should have been a mandatory requirement by department.

Cumberland County Health Department Our department currently does not have a proper notification protocol in place to alert all staff in the case of an emergency.

Update current safety plan to reflect necessary changes.

Cumberland County Health Department Drills need to be implemented for real life events that occur such as a shooter walking in the building. We only perform fire drills.

Second aspect for improvement would be to include a member from every department when planning a disaster response policy. Some individuals were not aware of the policy in place.

We are implementing changes in our plan. For instance, the panic button relay is delayed and needs to be improved by being connected to both floors in the department (two story building). The floor plans needed to be updated and displayed for the emergency responders as well as for the staff. The phone intercom system plan needs to be redistributed to all the staff (new employees).

Cumberland County Health Department Need to have a drill so that everyone is aware of procedures.

Overall security measures.

Virtua EMS Company has plans in place, plans were used and some questions were formed in a parking lot regarding issues or inconsistencies in plan.

Not a good idea to use parking lot in front of windows for evacuation due to active shooter. That is muster area for fire drills.

Virtua EMS Better understanding about the expectation that we were not to act as EMS.

Expectation of addressing the continuity of service. This was lost on us at first and was difficult to grasp at first.

More detail in policies of workplace violence.

Cape Regional Medical Center We will re-review our Active Shooter policy and make appropriate changes.



We determined that we needed clarification on the patient diversion section of our Code Triage / disaster plan.

Cooper Health System Ensure that all telephone trees and information included in the BCP as well as provided to the Lawson system is up to date in as near real time as possible and not just once a year.

Cumberland County Health Department We are a smaller scale agency and need to adapt a plan according to our size.

We need working panic button or alert system. Need escape routes visually mapped in the facility.

Actively practice a drill and escape routes.

Present to each department individually.

Cumberland County Health Department Emergency planning.

Additional staff and emergency training.

Annual refresher of emergency action plans.



APPENDIX C: ACRONYMS

Acronym Meaning

COMM Communications

CONOPS Concept of Operations

EOC Emergency Operations Center

ESF Emergency Support Function

IAP Incident Action Plan

HICS Hospital Incident Management System

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

Documents

After Action Report / Improvement Plan Healthcare · PDF fileSECTION 2: EXERCISE DESIGN SUMMARY ... The capabilities listed below form the ... After Action Report / Improvement Plan