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After Action Report / Improvement Plan Operation Muddy Waters – A Healthcare Coalition Exercise

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After Action Report Improvement Plan

Operation Muddy Waters A Healthcare Coalition Exercise

April 19, 2013

Region 2 Healthcare Preparedness Network Bremerton Washington



ADMINISTRATIVE HANDLING INSTRUCTIONS

1. The title of this document is The "Operation Muddy Waters - A Healthcare Coalition 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: Public Health: Jessica Guidry Region 2 Healthcare Preparedness Network (Office) 360-337-5267 (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 ......................................................................................... 28

APPENDIX A: IMPROVEMENT PLAN .......................................................................... 29

APPENDIX B: PARTICIPANT FEEDBACK (Strengths – Areas for Improvement) ........ 30

APPENDIX C: ACRONYMS .......................................................................................... 41



EXECUTIVE SUMMARY

Operation Muddy Waters - A Healthcare Coalition Exercise was designed and facilitated to provide participating agencies and organizations with an opportunity to evaluate current response concepts, plans and capabilities in response to a moderate earthquake followed by a severe flood occurring in Region 2 (Clallam, Jefferson, and Kitsap Counties).

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: Operation Muddy Waters - A Healthcare Coalition Exercise

Type of Exercise: Tabletop

Exercise Start Date: April 19, 2013

Duration: Three Hours

Location: Clallam, Jefferson and Kitsap Counties Washington

Sponsor: Region 2 Healthcare Preparedness Network

Purpose: The exercise was designed and facilitated to provide participating agencies and organizations with an opportunity to evaluate current response concepts, plans and capabilities in response to a moderate earthquake followed by a severe flood occurring in Region 2 (Clallam, Jefferson, and Kitsap Counties).

Scenario Type: Earthquake / Flood

Participant Information

Participant Location

American Red Cross - Olympic Peninsula Chapter

Clallam County Division of Emergency Management

Clallam County Health and Human Services

Harrison Medical Center

Jefferson County Department of Emergency Management

Jefferson County Public Health

Jefferson Healthcare

Kitsap Public Health District

Lower Elwha Klallam Tribe

Makah Tribe

Peninsula Community Health Services



Port Gamble S’Klallam Tribe

Number of Participants 88



SECTION 2: EXERCISE DESIGN SUMMARY

Exercise Purpose and Design

The exercise was designed and facilitated to provide participating agencies and organizations with an opportunity to evaluate current response concepts, plans and capabilities in response to a moderate earthquake followed by a severe flood occurring in Region 2 (Clallam, Jefferson, and Kitsap Counties).

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:

Operations Center Management

Activity Target Capability

# 1 Activate EOC / ECC / HCC

# 2 Direct EOC / ECC / HCC Tactical Operations

# 3 Gather and Provide Information

# 4 Identify and Address Issues

# 5 Provide EOC / ECC / HCC Connectivity

Scenario Summary

Heavy rain has begun to saturate the region in the days following a 6.1 magnitude earthquake occurring along the Seattle Fault. As various agencies and organizations continue to respond to meet the needs of area residents due to the earthquake, rivers begin to overflow their banks due to the prolonged heavy rain.



As the flood conditions worsen emergency management agencies and health care organizations throughout the region are faced with the serious challenge of responding to two separate disasters simultaneously.



SECTION 3: ANALYSIS OF CAPABILITIES


Performance Target Capability

Adequate Activity # 1: Activate EOC / ECC / HCC

Associated Critical Tasks

Task # 1.1: Activate EOC / ECC / HCC.

Adequate Washington Veterans Home

Observations None

Recommendations None

Strong Jefferson County Department of Emergency Management

Observations

Call out sheets are available, templates for developing an Incident Action Plan are readily available.

Emergency Operations Guides provide a strong framework / checklist to work from for both earthquake and flooding situations.

Recommendations Not necessarily an improvement, but in terms of sustainment,

all guides and checklists should be reviewed by every Incident Management Team member on a regular basis.

Adequate Jefferson Healthcare

Observations Team ready and willing to set up.

Recommendations Need to clarify roles for Command Center.

Adequate Jefferson County Public Health

Observations All designated staff arrived for the drill and understood that they needed to activate the ECC.


Strong Port Gamble S'Klallam Tribe

Observations Team assembled manuals.



Recommendations More outreach to community about emergency preparedness

needed (i.e. flyers and more exercises for community members and staff).

Adequate Clallam County Health and Human Services

Observations Our ECC was not in full operational mode (not needed for this exercise).


Weak Peninsula Community Health Services

Observations

The participants in the exercise did well with this step, although I feel they under estimated the time it would take to activate the EOC or in PCHS the ICS.

Most of the participants in the exercise had been through similar training in the past. So the team participating was adequate but as an organization we would be classified as weak.

Recommendations

Provide training to the entire staff. If we were in a true emergency / disaster the line staff would have no idea what needed to be done.

The majority have no idea what our Emergency Operating Plan is or where to locate it in our system.

The entire PCHS staff will receive some training on May 8th, but would recommend a drill for the staff after the training.

Adequate Lower Elwha Klallam Tribe

Observations

EOC was stood up within 30 minutes of incident. Participants were knowledgeable in standing up the EOC. ICS forms were available as well as the Comprehensive

Emergency Management Plan for reference.


Strong Harrison Medical Center

Observations All have some version of ICS. Good discussion about how HICS is similar to ICS to clarify

structure.


Strong Clallam County Division of Emergency Management



Observations

Positions in the ICS were pre-assigned. This contributed to a significant re-education in activation time. CCARES were quick to start message traffic because they were

also in pre-assigned positions.

Recommendations Provide more position specific training for IMT members.

Adequate Kitsap Public Health District

Observations

Players understood the criteria for when the ECC should be activated.

There was confusion about sending a representative to the county EOC and who should make the decision to send someone or should our EOC liaison immediately report.

Recommendations

A conversation needs to take place with KPHD directors and EOC liaisons regarding when and who should report.

The decision that is made during this discussion should be included in the ERP.

Adequate Makah Tribe

Observations EOC was activated in the Clinic Conference Room as per the STIHC EOP.

Recommendations Practice actual process for activating the EOC including all EOC team members who would serve during an incident.


Adequate Activity # 2: Direct EOC / ECC / HCC Tactical Operations


Task # 2.1: Establish organization / operation of EOC / ECC / HCC.


Observations None



Observations Focused emphasis on ICS has developed an Incident Management Team which is capable of assessing the situation,



developing priorities, and ensuring communications at all levels are effective

Recommendations Continue to train as new team members are brought on board.


Observations When does initial Incident Commander relinquish position or do they maintain?

Recommendations Define IC job role expectations and do table top training with entire group.


Observations

The four managers and one Communicable Disease program staff took ICS rolls.

Director was incident commander; Environmental Health Director and Communicable Disease Program manager were both Operations directors.

Deputy Director was logistics and financial director. Local Emergency Response Coordinator took over Plans and Liaison.


Adequate Port Gamble S'Klallam Tribe

Observations Consulted public health emergency manual and Port Gamble S’Klallam Tribe EOC plan.

Recommendations Need more staff training on areas of responsibility and role assignments in coordination with tribal EOC plan.


Observations None


Adequate Peninsula Community Health Services

Observations

The PCHS Emergency Operating Plan (EOP) clearing outlines the steps to be taken with establishing operations.

The participants were able to locate the information and know what their roles were during the exercise.

There was some discussion regarding which staff would be responsible for what roles during a true emergency / disaster.



Recommendations

Part of the discussion was who do we identify as an incident commander in an emergency / disaster as there is not always a manager on site?

The suggestion was made to train possible incident commanders.


Observations

Incident Commander was established immediately. IC selected and directed job tasks in relation to experience. Good communication among the group. There was flexibility in accessing personnel, good problem

solving between EOC personnel.

Recommendations Public Affairs Officer was not appointed. Recommend PIO be involved at the onset or as soon as

possible.


Observations None


Adequate Clallam County Division of Emergency Management

Observations Needed more conversation between all four positions.

Recommendations Provide more exercise opportunity to thoroughly analyze

materials as a team (with a minimum of four people) using assumptions, historical data and thinking outside of the box.


Observations

The players understood the ICS roles. There was a lot of discussion about how the roles would be

assigned was situational. However, after the discussion centered on the nature of the

scenario at play, they determined who would fill the ICS roles.

Recommendations

More exercising and drills involving ECC set up would help clarify how roles should be filled.

Involve more non-ECC / non-management staff in future exercises and drills.

Weak Makah Tribe

Observations Only one staff member attended the exercise limiting the ability



to evaluate a fully operational Clinic EOC.

Recommendations Ensure that staff members assigned to work in the Clinic EOC during an emergency or disaster participates in exercises.

Task # 2.2: Coordinate management of EOC / ECC / HCC with other ICS / HICS operations.


Observations None


Adequate Jefferson County Department of Emergency Management

Observations Communications via satellite phone with the hospital were not possible early in the exercise. .

Recommendations Phone numbers and contact points need to be continually

updated and checked to make sure they are correct and operating.


Observations Communications were successful but did not participate in coordination with outside agencies.

Recommendations Dedicated fax and computer for communication room. Hand crank weather radio.


Observations Limited staffing but covered the essential areas.



Observations Staff knows where to turn to get information and resources.

Recommendations Do mock contact drills.

Not Applicable Clallam County Health and Human Services

Observations No coordination was necessary for this exercise.





Observations

After several tries the participants were able to connect with our designated contact for the exercise, they felt it was due to the contact was also trying to reach us at the same time.

Also the participants reached out to a community partner not participating in the exercise and was put on hold twice and then sent to someone's voicemail. They did not receive an answer to the question "What are your organization's roles and responsibilities in responding to an earthquake?"

The participants also discovered the location of the satellite phones might not be optimal.

Recommendations

Do a community outreach to the partners who were not participating in the exercise on Friday April 19, to firmly establish their roles in an emergency / disaster.

Re-evaluate the location of the satellite phones and the posting of each phone number. The reason for this is due to the fact if the phone is in an unknown location to the staff the clinic may be "cut" off if traditional lines of communication are unavailable.


Observations

Management of EOC established in accordance with the Comprehensive Emergency Management Plan.

Section Chiefs were appointed along with job task sheets and ICS forms.


Adequate Harrison Medical Center

Observations Phone lists at county EOC may not be up to date. However, all participants felt that they could get in touch with

their counterpart / colleague if needed.

Recommendations Regular, scheduled updating of all phone lists that would be needed during a disaster.

Weak Clallam County Division of Emergency Management

Observations

CCARES and IMT were well throughout the exercise as individual units.

Would like to have seen more information sharing ( formal and informal) discussions.

Recommendations Increase cross training and multiple agency exercises. Create



objectives to drive inter-agency collaboration during the trainings and exercises.

Not Applicable Kitsap Public Health District

Observations None



Observations STIHC EOC was able to work successfully with other tribal

departments and the Makah EOC to handle the earthquake response and public health incident.

Recommendations Include members of the Makah EOC on site to improve discussions and further develop response plans.


Adequate Activity # 3: Gather and Provide Information


Task # 3.1: Ensure appropriate notifications are made.


Observations None



Observations Checklists provide a comprehensive list of notifications which should be made.

Recommendations Continue to review and test notification numbers to ensure they are still viable.

Strong Jefferson Healthcare

Observations Sit rep sent to DEM within minutes of IC stand up. Some difficulty accessing call list.

Recommendations Team would like additional training in IAP development. Call list needs some updating.




Observations Internal staff notified.



Observations

CHR's and RN outreach in place. Plan to prepare and distribute flyers Using Facebook to

disseminate information Use of HAM radio and CB's.

Recommendations

Get HAM radio training and certification in place. Better storage of HAM radio. Need hand held radios. Need backup HAM radio unit.


Observations None



Observations PCHS EOP clearly outlines the steps to take and the participants were able to locate and follow the plan.

Recommendations Again training the line staff to know where to locate the

information needed in an emergency / disaster. PCHS plans on a training at our all staff meeting on 5/8/13.


Observations

Notifications were made to CERT / MRC members. Facilities were identified and contacted for evacuees, Tribal

police notified, clinic notified and a systematic approach was utilized.

Tribal council was also notified along with communications contact with Clallam County EOC.

Recommendations Recommend PIO be notified as soon as possible and request

PIO to handle rumor control via social media sites and press releases with County PIO.




Observations None



Observations IMT created a strong list of resources to contact. Needed more pre-established resource lists and their

capabilities to expedite call out / notification time.

Recommendations EOC staff should expand the resource contact information

available in the EOC. More maps needed in the EOC

Strong Kitsap Public Health District

Observations Staff and partner notifications priorities and processes were clearly understood.

Recommendations Practice of internal notification would be good follow-up,

especially for non-ECC staff. Clarification is needed regarding DOH duty officer notification.


Observations STIHC EOC was able to generate public info messages for Makah EOC to disburse.

Recommendations Develop pre-made public info messages for any major public health hazards the Tribe might face.

Task # 3.2: Coordinate emergency management efforts among local, county, regional, State and Federal EOC.


Observations None



Observations This aspect was not tested in this exercise.

Recommendations An update by FEMA Region X on what counties could expect

during a prolonged disaster response / recovery situation may be valuable.



Not Applicable Jefferson Healthcare

Observations None



Observations Contacted Jefferson County DEM by phone and regional partners through HAM system.



Observations Have relationships with County, State and Federal agencies. Mutual aid agreement with Kitsap County Health Department.

Recommendations Practice tribal mutual aid agreement.


Observations None



Observations

Not all of the participants clearly understood where we fall in the EOC. Meaning our role is defined by the County / Regional EOC and we are expected to follow the direction of the EOC in an emergency / disaster.

Once our role was clarified the participants were able to understand what PCHS was expected to do and who the contacts would be to coordinate efforts.

Recommendations During training explain what the PCHS role is expected to be in an emergency / disaster that affects the region.


Observations

Coordinated emergency management efforts with Fire District 2, Clallam County EM, FEMA, Army Corp of Engineers, American Red Cross, Washington EMD), Indian Health Services and County Health Department.

Recommendations Concerns regarding pet shelters. Good discussion for future implementation of pet shelters.




Observations Strong sense of interdepartmental collaboration.



Observations

IMT worked with a Federal agency representative on their ICS team.

This worked well with seamless transition to form the team and provide useful information beyond the scope of the IMT's working knowledge.

CCARES had pre-established strong plans to connect with local, NGO and Tribal organizations.

They were successful in following through.


Not Applicable Kitsap Public Health District

Observations None



Observations Makah EOC was not present at the exercise but communication with them were mentioned and their probable response.

Recommendations Include Makah EOC team members in the exercise.

Task # 3.3: Coordinate with non-governmental agencies and / or private sector to collect / share data on incident situation.

Weak Washington Veterans Home

Observations None

Recommendations More contacts needed.


Observations

Incident Management Team has strong community ties and is extremely effective in obtaining information and ensuring ongoing operations in concert with non-governmental and private sector agencies.




Not Applicable Jefferson Healthcare

Observations None



Observations Contacted Jefferson Healthcare by phone.


Not Applicable Port Gamble S'Klallam Tribe

Observations None


Not Applicable Clallam County Health and Human Services

Observations The EOC would share this information.



Observations

From the PCHS side of things we would be willing to coordinate with the non-governmental agencies / private sector but the general consensus of the participants is the private sector would not be participating in any sort of emergency / disaster response.

Recommendations

Reach out to the private sector to encourage participation in response activities.

Not sure if this is a PCHS level action or needs to be done on a wider scale.


Observations

PIO to share press release with local paper / news. Collect and share data with local utility companies (phone,

water, power, etc.). Request damage assessments from people out in the field via

Ham radio.





Observations Referenced local supply chain to assist in case of emergency.


Not Applicable Clallam County Division of Emergency Management

Observations This action was discussed, but there was not an opportunity to

practice these actions. CCARES did complete these actions.

Recommendations Use full scale exercise in future.


Observations

The players understood that this type of notification should generally happen from the EOC.

Public Health might take more of lead for notification of the healthcare.

Recommendations Practice with more and varied scenarios would help.

Weak Makah Tribe

Observations Was not able to use satellite phone since IT person was not present that day.

Recommendations Ensure satellite phone is available for emergency / disaster events that can be used to contact outside agencies.


Adequate Activity # 4: Identify and Address Issues


Task # 4.1: Identify, elevate and address needs / issues.


Observations None





Observations

Because the county is small and resources are often located outside of our jurisdiction, the Incident Management Team is adept at recognizing issues and elevating needs early in disaster response / recovery operations.



Observations Team identified resources needed for safety and security of

staff and patients, security of building, shelter in place and ongoing continuity of care.

Recommendations Verify MOU with local sanitation company. Incident Commander needs ability to know what staff are in

house for off hour events.


Observations Environmental Health Director quickly identified public health issues.



Observations We were mindful of need to keep community informed, safe and well supplied.

Recommendations

Have community mock drills. Develop vulnerable community member list to prioritize needs Develop list of community members with health and specialized

skills (i.e. HAM radio, technical skills etc.).


Observations None



Observations

The participants were able to disseminate the facts presented and know what steps were needed to maintain operations.

They were able to solve any supply issues and staffing considerations again to maintain operations at four of the five PCHS locations.



Recommendations

Would recommend a clear alternate plan for supplies, as the supply companies would need to be notified about change of delivery address if the 6th Street clinic were not operational as all the supplies are delivered to the one location then delivered to the other three clinical and admin sites.


Observations

Pet shelter is an issue and future plans will be initiated to address this issue.

Cell phone reception is not available in bunker EOC. Water contamination is a concern due to broken pipes and

flooding. PIO to release directions on making water safe to drink. Long term resource shortages: Debris and garbage pickup,

power outages and displaced people. Contact hotels outside of affected area for continued shelter. Clallam County EM to assist in long term resources.

Recommendations Research geographical areas for establishment of pet shelter.


Observations ICS methodology.



Observations Discussions by IMT members covered these issues.

Recommendations

An exercise debrief on identified issues should be held jointly with the full membership of the IMT and the CCARES corps.

This would help with expediting full team involvement in addressing this issue with a significant and valuable improvement action plan.


Observations The players understood priorities and where interventions needed to be directed.

Recommendations More practice in documentation of priorities and completing IAPs.


Observations STIHC EOC staff was able to identify the issues at hand,



develop an action plan, and list needed resources.

Recommendations Include other staff in exercise to ensure that every area is covered.


Adequate Activity # 5: Provide EOC / ECC / HCC Connectivity


Task # 5.1: Implement response communications plans and protocols.


Observations None



Observations Emergency Operations Guides provide a sound roadmap for establishing communications protocols.



Observations Verified communication with DEM and Public Health.



Observations Public Health information including public safety messages was identified and communication networks were reviewed.


Not Applicable Port Gamble S'Klallam Tribe

Observations Communications, plans and protocols handled by main tribal EOC.

Recommendations Identify titles and roles for main tribal EOC.




Observations None



Observations

The participants were able to initiate communications plans and protocols with clear understanding of how the clinics would function until the emergency / disaster were done i.e. how to communicate with patients and staff.

Recommendations

Again PCHS needs to review the location of the satellite phones (where they are housed at each location), as the phones are located in offices that not every staff would have access to.

Would like to have confirmation the staff contact list is kept in a location accessible off site per the EOP and who has access to the list as it is not outlined in the EOP. As there is not an overall recommendation location: The EOP is available on the PCHS network drive currently.

If it was an emergency / disaster situation where that was not available it is not clear if there is an updated version at each location easily accessible by all staff not just senior leaders.

PCHS has updated the emergency flip chart and will have them available in the clinic and administration locations within the next two weeks, but the flip chart is only a snap shot of what needs to be done.


Observations

EOC communications with other agencies relies on landline phone lines, ethernet internet connectivity, and Ham radio.

All communication systems aside from cell phones were operable for the duration of the exercise.

Communications were effective, loud and clear.



Observations None


Weak Clallam County Division of Emergency Management

Observations Only opportunity was in inject # 5.

Recommendations Add more outreach injects to future exercises.



Include message traffic injects between the CCARES and IMT that would be sent out to outside resources and organizations that would have a reply requirement.

The cache of those responses should be examined and integrated into the EOC planning process and used as an improvement action plan. These changes would then be tested in future exercise objectives.

Strong Kitsap Public Health District

Observations The players knew the communications options and how and when to implement.

Recommendations More practice with ham equipment would be a good idea, especially with hand held units, using simplex and doing relays.

Weak Makah Tribe

Observations Communications plans did not provide clear direction on roles and responsibilities.

Recommendations Communications plans need to be further developed.



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 the exercise participants are strong as well as identifying areas that the departments should invest future planning, training and exercise funds on.


Activity Target Capability Performance

# 1 Activate EOC / ECC / HCC Adequate

# 2 Direct EOC / ECC / HCC Tactical Operations Adequate

# 3 Gather and Provide Information Adequate

# 4 Identify and Address Issues Adequate

# 5 Provide EOC / ECC / HCC Connectivity Adequate



APPENDIX A: IMPROVEMENT PLAN

This Improvement Plan has been developed specifically for exercise participants based on the results of Operation Muddy Waters - A Healthcare Coalition Exercise conducted on April 19, 2013. These recommendations draw on both the After Action Report and the After Action Conference.

Capability Observation Recommendation Responsible

Agency Completion

Date

Activate EOC / ECC / HCC

Direct EOC / ECC / HCC Tactical Operations

Gather and Provide Information

Identify and Address Issues

Provide EOC / ECC / HCC Connectivity



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

Strengths

Organization.

Communication.

Exercise participants demonstrated excellent teamwork.

Radio checks went well.

Team awareness of Emergency Operations Guides and their use within the EOC.

Radio communications between Jefferson Healthcare and Jefferson Public Health.

Establishing communication with Public Health.

The website functioned smoothly.

We were able to maintain communication through our satellite phone.

We were able to utilize and find things with our action plan.

Flexibility in accessing additional personnel.

Emergency communications.

Problem solving communications among EOC Staff. Demonstrated knowledge and competence in this situation / incident.

EOC members work well together as a team.

Scenario flowed smoothly.

Scenario based on a real world aspect that could happen in our area.

Team discussion and decision making.

Communications went well.

A heightened awareness of current plan.

Identified areas of the plan that need improvement.

Scenario was realistic and caused the exercise participants to extensively review plans.

Exercise led discussion into topics not regularly addressed.



We worked together well as a team between EH and CH.

Emergency plans are well organized. New EH appendix is helpful.

We communicated with DEM, Jefferson Healthcare and HAM radio with region.

Referred to ERP.

Multiple HHS sections in same room for exercise.

Communication between team members worked well.

The exercise made us focus on the action plan needed.

Found alternate ways to access information when standard methods didn't function.

Good reminder on where information is and what has already been planned.

Format worked.

Successful briefing of one of the Jefferson County Public Health officials on the correct use of her ham radio.

All ham radio qualified healthcare officials successfully checked in to the Jefferson County healthcare net, for which I served as the Net Controller.

After completing my responsibilities as the Jefferson County Healthcare Net Controller, I was able to check in to the Region 2 nets in both Kitsap and Clallam Counties.

Communication with other agencies.

Work together as a team well, especially CD and EH staff.

Emergency plan well organized, New EH section was helpful.

Was able to contact DEM, Jefferson Health care and use HAM Radio to connect with regional partners.

Getting the correct people in the room.

Discussion among participates was good.

Coordination between EH and CD.

Locating procedures in the manual.

Communication with partners.

The participants effectively used the PCHS emergency operations plan.

The participants respected each other and allowed everyone to speak their opinions.



We were able to identify areas where improvement is needed.

Had needed staff in the room.

Event was believable so able to plan.

Team worked very well together. EH, CD and administration great group.

Plans both regional and JCPH great. Well organized easy to use, new EH application thorough..

Phone contact with partners worked better than usual..

Organization was directionally prepared.

Communications.

The equipment and tools available to us.

Communication between players was very good.

The Emergency Response Plan was available for use.

All computers used in the scenario worked.

The ONX System worked well.

Our satellite phone system functioned properly.

The drill allowed the group participants to use the emergency plan and evaluate its effectiveness.

We used our emergency operations plan to guide us through the decision making process.

We activated our EOC and each member knew their ICS positions and responsibilities.

Our communications (satellite phones) worked well.

Overall positive experience working together.

Participants could easily identify other relevant local and state partners.

The exercise was overall well-organized and put together.

We had knowledgeable staff available to respond to the situations that needed to be addressed in this exercise and the team worked well together. .

Gave us the opportunity to review and note changes that we need to make and / or improvements in our current systems.



It was nice to have a PH / EH component in this exercise that really allowed us to have good discussion about what we would do in an urgent situation.,

On site Incident Commander and Division Commanders worked together smoothly and professionally.

Procedures and focus shifts took place as needed. Demonstrating appropriate focus transition as issues developed.

Wrap up and review were concluded with recognition and action on the shortfalls.

Good problem solving, i.e. water testing issues, with Environmental Health there.

Good discussions, what if certain problems were encountered.

Hospital Incident Command for the hospital was great! Good team work, team play and discussion as injects developed.

Setting up and testing our communications.

Training new HICS team members via this ogling drill.

At least 1 representative from Public Health, Environmental Health, Human Services, Administration and the department director attended and were able to contribute information and provide direction specific to their specialty.

We were able to utilize and evaluate our Region 2 Emergency Response Plan.

The exercise was "user friendly" and allowed for open discussion.

The online site functionality (site, video, audio) was flawless.

The time provided for each phase was adequate and the counter helped to keep the group on task.

The disaster scenarios were realistic and relevant which created an aspect of true response coordination discussions.

We were able to work as a team.

Communications were available via satellite phone.

We have resources and supplies set aside and we all knew where.

Our team worked well together.

I thought our team worked well together in discussing the scenario, accessing information in our emergency preparedness plans and providing relevant answers to the questions.



Testing of our communication equipment (HAM radio and triage cell phone) went well.

RN / clinic staff had a good handle on how to respond to the scenario of contaminated water; accessing information and support from our local health department.

Our team worked together well with all members participating.

We were able to complete all parts of the exercise with the information we had in our EOC.

This exercise provided a scenario that is very probable for our area.

Good group participation.

Used our policies and procedures to guide us.

Discussion groups were effective.

The coordination between the departments.

We were able to work through all of the scenarios as they were presented.

Initial set up of EOC was smooth and controlled. IC was identified quickly along with other sections.

Excellent problem solving techniques between the EOC personnel. Discussions were on target.

Knowledge of resources from EOC personnel was high.

All parties that were expected to attend did.

Everyone felt very comfortable with open discussions.

A lot of "outside the box" thinking occurred.

Team organization.

Good material.

Calling other sites and places.

Worked well as a team. EH and CH staff were important to this exercise and worked very well together.

Emergency plans well organized.

Communication with partners worked (DEM, Jefferson Healthcare and Ham radio).

Clarification of roles within our ECC.



Discussion about handling of media releases.

I witnessed Jared Keefer, Environmental Health and Water Quality Director, and Lisa McKenzie, PHN specializing in Communicable Disease, work very well together in this exercise.

Our emergency plans are well organized.

We had no problems communicating with DEM, Jefferson County Healthcare or using the HAM radio.

Each participant knew where they would be expected in a time of need. It was easy to lay out who would take care of which duties, had something actually occurred.

Group works will together. One idea or comment leads to more thinking and discussion participation from the others in the group. Very easy to understand each other.

There was a lot of knowledge from each in the group. Some knew a lot of case work, while others knew more about contacting the correct facilities, healthcare, administration and finances. The group was able to bring it all together and make sense of everyone’s responsibilities.

Preparing our data in an organized fashion, thinking about how long we could serve the community without producing additional water via pumping.

Talking with Harrison Hospital about emergency preparedness.

Comparing seismic security systems with the City of Bremerton. Our systems are similar, but it was interesting to hear how they work.

Brought together Facilities Engineering and Water Purveyors to discuss Memorandums of Understanding (Bremerton) and general information (Silverdale) that exists between the medical center and water purveyors.

Have a greater understanding of everyone's priorities.

Know how to access partner agencies after hours.

Clinic staff were able to use plan to determine necessary actions.

Exercise helped staff familiarize themselves with the EOP.

Exercise identified areas of the plan that need improvement and that additional training is recommended for staff.

Areas for Improvement

More practice.

More practice.



More practice.

Coordination of protocols between agencies so that everybody clearly knows what the other is doing.

Institute real time drills.

We need to further develop our COOP.

Look for ways for PCHS to better prepare community for disasters.

Update evacuation routes and methods. Animal safety and recovery.

Regular updates to EOC and CERT lists. Update contact lists.

Educate community on siren warnings.

Fine tuning our current plan.

Edit our phone book.

Computer, fax, and radio hand crank for communication room.

Emergency plans need further development and staff needs to be trained.

Further develop working relationships with Makah EOC and outside agencies.

Ensure backup communications equipment is available and in working.

We need to review and examine at a programmatic level COOP.

Review ECC SOP binder prior to training.

Need better IT communications.

Cell phone access in basement during actual emergency. Emergency phone in ECC. No satellite phone.

Need hardcopy of ERP in ECC cabinet after adding demobilization procedure in ECC section.

Reevaluate inter call down procedure, add section managers and all staff to section managers list.

Community partner information needs to be organized for more functional access.

We got too caught up in assumptions and second guessing of decisions to be made.

We need to be more familiar with our OPARC disaster operational plan.

Have someone from the EOC at the exercise PHEPR can review social media issues



(happy medium between maintaining active account without too much). See if it is working well in other areas. PHEPR to see if PIERS can transmit our items. Update flash drives. Update plans with documents.

Improve access to staff cellphones, be clear on what boilerplate information is out there and adequate, since we just transferred PIO he needs to ensure transmission of releases remotely, get ERP available electronically like in iBooks, need to become more familiar with risk communications

From my central location as the Net Controller in Jefferson County, perhaps in the future I might be able to enlarge the net of participants. Even though an individual participant will not be able to hear everyone else, I will be in a position to relay.

Updated call list.

Personnel tracking system.

Fax / compute r/ hand crank radio for communication room.

Update COOP at a program level in the department.

Need to review Emergency Coordination Centers Standard Operating procedure notebook.

Information Technology needs updating.

Emergency Response book did not have list of things to address in possible emergencies types i.e. looks for these issues during an earthquake, look for these issues during a flood.

Communication problems - no phones working.

Need list of resources during emergencies.

Initial Action Plan development.

Procedure layout in our manual.

Initiating our continuity of operations plan.

PCHS can improve on our community outreach / education about preparedness. We do not currently reach out beyond our staff.

Prepare and initiate an organization wide real time drill.

Identify possible incident commanders and offer training on what to do in an emergency / disaster situation.

Could not access cell phones from our area.



Contact with others involved such as emergency management.

JCPH operations plan in emergency needs a programmatic update. Overall plan good but holes at program levels.

Built teams, now need to go deeper in organization to include more staff.

Line Staff Training.

Help in Community Preparation.

More communications regarding supplies of such thing as water with other participating organizations.

No emergency phones available in the ECC. Cell phones do not work.

Need demobilization procedure in the Emergency Response Plan.

PCHS needs employee level training and expectations given to the employees from the administration regarding disaster events.

Training for incident commanders and back up incident commanders.

Drill staff rather than a small group of leaders.

Staff emergency preparedness at home

Educate staff on what emergency supplies the organization has on hand and where they are kept.

Train more staff on NIMS / ICS.

Cell phones don't work in the basement! This seems like a big problem that must be remedied.

We found out about materials / supplies we need to be sure to have in this building.

Need cell phone / emergency phone ability in the ECC.

It would have be nice to actually have contact and work / communicate with our EOC staff.

We need to have a hard copy emergency response manual in the ECC at all times.

Broader perspective was needed on potential complications and eventualities.

We were a bit too idealistic with our original assessments.

The huge Emergency Response manual, how to locate pertinent information.

Improve and update telephone tree.



Update the overall Emergency Operations Plan.

Develop current job descriptions for each HICS position.

Stay on task and not get off topic.

We all need the same resources, the flip chart, the supply list etc.

Communicating with other departments.

While we knew our staff assignments for the clinic and health department EOC - we did not have the tribal name assignments for the "tribal" organization EOC.

Our community is small enough that it would be good for us to have a list of our vulnerable adult and elders that we could target for home visits post emergency scenario.

We can always use more and more practice.

Make sure that all of our media and electronic equipment is working well.

Make sure that we keep all of our resource and contact information as current as possible.

Our initial setup could be more effective with outlines tasks.

Well defined job descriptions with proper employees identified and outline of responsibility’s.

Policies could be better.

Educate community on siren activation, update evacuations routes and methods.

Pet shelter identification, policies and procedures for pet preparedness.

Regular updates to EOC and update contact list for CERT members.

Staying on the topic. We tended to veer off onto another thought, although they were useful ideas.

Review continuity plan and possibly improve for specific programs.

Review ECC system of operations regularly.

Need better IT connections.

Provide training to expand public contact to Twitter and Facebook instead of relying solely on media releases.

There needs to be review of the continuity plan and possible improvement for specific



programs.

We need to schedule regular review of our ECC SOP's.

We need better IT connections and backup plans.

Work with the Tribal planner on their Emergency Preparedness contract and maybe coordinate exercises with them.

Make sure all updated information is being used in the handbooks. Make sure everyone knows where to find the books in case one person needed to find them.

More staff should be HAM Radio certified. A second HAM radio at the store farther up the hill should be installed in case the one down the hill at the tribal center is blocked of by road damage, etc.

Developing a true MOU with Harrison Medical Center about how we plan to serve them after a disaster.

Additional training and exercising for the Silverdale Water Employees. Personnel planning needs improvement within our agency.

Continued coordination with Kitsap's emergency management. We need to communicate system changes to EM more often.

Need to update MOU with Bremerton.

Need to create MOU with Silverdale.

Emergency Operation Plans could use further development.

Additional clinic staff needs to attend the exercise.

EOP needs to be exercised at least annually to evaluate effectiveness of plan and staff.



APPENDIX C: ACRONYMS

Acronym Meaning

CD Communicable Disease

COMM Communications

CONOPS Concept of Operations

COOP Continuity of Operations Plan

EH Environmental Health

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

Documents

After Action Report / Improvement Plan Operation Muddy ... · After Action Report / Improvement Plan Operation Muddy Waters – A Healthcare Coalition Exercise Disaster Resistant