AFTER ACTION REPORT/IMPROVEMENT PLAN...2010/01/07 · Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan Health Survey 2010 ~ 2 ~ Administrative

Health Survey 2010

October 23, 2010

AFTER ACTION

REPORT/IMPROVEMENT PLAN Publication Date: January 2011

Greater Nashua Public Health Region

City of Nashua, Division of Public Health &

Community Services

Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan Health Survey 2010

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Administrative Handling Instructions

1. The title of this document is Health Survey 2010 After Action Report and

Improvement Plan

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. Reproduction of this document, in whole or

in part, without prior approval from the City of Nashua, Division of Public Health

& Community Services is prohibited.

3. Points of Contact:

Ashley Conley, MS, CPH

Epidemiologist

City of Nashua, Division of Public Health & Community Services

18 Mulberry Street

Nashua, NH 03060

603-589-4552 (office)

[email protected]

Patty Crooker, MPH

Regional Public Health Preparedness Coordinator


18 Mulberry Street

Nashua, NH 03060

603-589-4507 (office)

[email protected]

mailto:[email protected]

mailto:[email protected]


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Table of Contents

Administrative Handling Instructions ................................................................................. 2

Table of Contents ................................................................................................................ 3

Executive Summary ............................................................................................................ 4

Major Strengths ................................................................................................................... 4

Primary Areas for Improvement ......................................................................................... 4

Section 1: Exercise Overview ............................................................................................. 5

Exercise Details .............................................................................................................. 5

Exercise Planning Team Leadership ............................................................................... 6

Participating Organizations ................................................................................................. 7

Section 2: Exercise Design Summary ................................................................................. 7

Exercise Purpose and Design .......................................................................................... 7

Exercise Objectives, Capabilities, and Activities ............................................................... 9

Scenario Summary .......................................................................................................... 9

Section 3: Analysis of Capabilities ..................................................................................... 9

Capability 1: Communications ..................................................................................... 10

Capability 2: EOC Management ................................................................................... 11

Capability 3: Epidemiological Surveillance and Investigation ..................................... 12

Other Strengths and Areas for Improvement: ............................................................... 13

Capability: Volunteer Management .............................................................................. 13

Capability: Planning and Preparation ........................................................................... 14

Section 4: Conclusion ....................................................................................................... 16

Appendix A: Improvement Plan ....................................................................................... 17

Appendix B: Participant Feedback Summary ................................................................... 21

Appendix C: Exercise Events Summary Table ................................................................. 28

Appendix D: Acronyms .................................................................................................... 30

Appendix E: THANK YOU TO OUR VOLUNTEERS!!! ............................................... 31

List of Tables Table 1: Health Survey 2010 10-23-10 Events Summary ................................................ 28

Table 2: Health Survey 2010 11-6-10 Events Summary .................................................. 29

Table 3: Acronyms ............................................................................................................ 30


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Executive Summary

The Greater Nashua Public Health Region and the City of Nashua Division of Public

Health & Community Services (DPH&CS) operations based functional exercise “Health

Survey 2010” was developed to test communications capability, emergency operations

center management, and epidemiological surveillance and investigation capabilities.

The exercise planning team was composed of numerous and diverse agencies, including

regional partners, public health network coordinators, organizations from the Community

Health Assessment Advisory Board, medical partners and the local colleges. The

exercise planning team discussed the logistics regarding the content and length of the

health survey, qualifications for participation as volunteer, avenues to publicize the event

to diverse communities, and the operational support needed at the command post to

ensure the safety and efficiency of the event. Based on the exercise planning team’s

deliberations, the following objectives were developed for Health Survey 2010:

Objective 1: To test our communications plan using landlines, cell phones, walkie

talkies and radios.

Objective 2: To coordinate the health survey, allocate resources, provide support

and maintain communication with our volunteers.

Objective 3: To gather health data from 210 residents using the Center for Disease

Control’s Community Assessment for Public Health Emergency Response

(CASPER) protocol and Capturx digital pens and paper.

The purpose of this report is to analyze the results from the exercise, identify strengths to

be maintained and built upon, identify potential areas for further improvement, and

support development of corrective actions.

Major Strengths The major strengths identified during this exercise are as follows:

Issues that arose for survey teams were handled quickly and efficiently.

Bilingual survey teams were available throughout the day.

Pre-event the media campaign helped to notify residents of the health survey.

Primary Areas for Improvement Throughout the exercise, several opportunities for improvement in the Greater Nashua

Region’s ability to respond to the incident were identified. The primary areas for

improvement, including recommendations, are as follows:

Team leaders were not able to reach the survey teams at all times. Team leaders

should enforce the importance of the communications checks to the teams. One


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individual on each team should be assigned as the communication lead and be

responsible for answering calls from the command post and/or team leaders.

Incoming calls became overwhelming when many of the survey teams were

calling in to the team leaders at the same time. Handheld radios instead of walkie

talkies should be used to enhance communications and efficiency. The command

post could also set-up a bank of phones with support staff for the teams to call

while in the field.

Support staffs that are sent into the field to deliver lunches, equipment, etc should

be in teams of two to ensure safety and increase efficiency.

Overall, the exercise was a success and the Region was able to implement the CDC’s

CASPER protocol. The teams reached their starting points promptly, equipped with all

the materials and resources needed to navigate Nashua’s neighborhoods in a safe manner.

They interacted cordially with residents to complete the surveys, communicated with the

command post and team leaders. In the end, 207 of the 210 health surveys were

completed from 30 randomly selected neighborhoods in the City of Nashua.

Section 1: Exercise Overview

Exercise Details

Exercise Name: Health Survey 2010

Type of Exercise: Functional Exercise

Exercise Start Date: October 23, 2010

Exercise End Date: October 23, 2010

NOTE: Teams of volunteers also went into the community to gather additional

surveys on November 6, 2010. Evaluations and information gathered from this

event will also be added to this report even though the “official” exercise was

performed on 10/23/2010.

Duration: 1 day or 8 hours (0800hr – 1600hr)

Location: Division of Public Health and Community Services, 18 Mulberry Street,

Nashua, NH 03060 and 30 randomly selected neighborhoods in the City of Nashua

Sponsors:

New Hampshire Department of Health and Human Services,

United States Department of Health and Human Services/Centers for Disease

Control and Prevention,


St. Joseph’s Hospital,

Southern New Hampshire Medical Center,


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Nashua Area Health Center.

Capabilities: Communication, Emergency Operation Management, and Epidemiological

Surveillance and Investigation

Scenario Type: Operations-based

Exercise Planning Team Leadership

Project Coordinators:

Ashley Conley, Epidemiologist

Division of Public Health and Community Services

18 Mulberry Street, Nashua, NH 03060

[email protected]

603-589-4552

Patty Crooker, Regional Public Health Preparedness Coordinator

Division of Public Health and Community Services

18 Mulberry Street, Nashua, NH 03060

[email protected]

603-589-4507

Community Health Assessment Health Survey Committee

Victoria Alabi, Public Health Associate

DPH&CS

Primary Author

Mike Amichetti, Case Technician

DPH&CS

Theresa Calope, Public Health Nurse

DPH&CS

Amy Cullum, Senior Consultant

Community Health Institute

Debbie Daniels, Medical Director

DPH&CS

Corinn Dembkoski, Public Health

Specialist

DPH&CS

Mariellen Durso, Director

Nashua Area Health Center

Meredith Lyons, Environmental Health

Specialist

DPH&CS

Ray Peterson, Vice President

United Way of Greater Nashua

Technical Assistance: Beatrice J. Selwyn, ScD, Associate Professor, University of Texas

School of Public Health


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Participating Organizations

City of Nashua, Assessing & GIS Department

City of Nashua, Board of Health


City of Nashua, Risk Management

City of Nashua, Police Department

Community Members

Dartmouth-Hitchcock

Gateways Community Services

Greater Derry Medical Reserve Corps

Greater Nashua Public Health Region

Greater Nashua Mental Health Center at Community Council

Hillsborough County Amateur Radio Emergency Services


Nashua Community College

Nashua Police Athletic League

NH Department of Health & Human Services

NH Gateway Chapter of the American Red Cross

NH Homeland Security & Emergency Management

Parent Coach

Rivier College

Southern New Hampshire Medical Center

Southern NH Services

St. Joseph Hospital

St. Luis de Gonzague Parish

Number of Participants

October 23, 2010 November 6, 2010

Volunteers: 33 Volunteers: 26

Evaluators: 1 Evaluators: 0

Support Staff: 9 Support Staff: 5

Section 2: Exercise Design Summary

Exercise Purpose and Design

The Division of Public Health and Community Services identified the Community Health

Assessment (CHA) as a primary need in its strategic plan in 2009. The overall goal of the

CHA is to gather and analyze health data on the Nashua community and use this data to

inform and focus the Division’s health programming. The health survey was identified as

the best tool through which to gather this information directly from the community. The

coordinators of the exercise reviewed similar studies done by other health departments


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and recognized this opportunity to conduct the survey according to the CDC’s

Community Assessment for Public Health Emergency Response (CASPER) protocol.

This type of rapid needs assessment is usually performed following disasters or large-

scale emergencies. Trained in using the CASPER protocol, the coordinators organized

this exercise so that the benefits would be two-fold: collecting health data to improve the

health of the City of Nashua and practicing epidemiological investigation in emergency

situations with volunteers trained in using the protocol. The hope is that the Greater

Nashua Public Health Region can develop a protocol based on these experiences that can

be used following a disaster or large-scale emergency.

Thirty teams of volunteers would visit thirty neighborhoods in Nashua and

interview a total of 210 residents using the health survey. The neighborhoods were

randomly chosen using a cluster sampling method that was first used by the World Health

Organization for determining immunization status. A cohort of volunteers was recruited

through an application process and attended a full day training. The command post was

set up at the DPH&CS with enough team leaders and staff to support the volunteers when

out in the field.

Each team was provided with a map of their walking path that pictured the houses

to be interviewed in their assigned block group. The maps included legends which

directed teams on how to keep track of the houses surveyed, those that refused, had a

language barrier or had no one at home. The survey contained 34 questions covering a

variety of health topics that include access to care, oral health, chronic diseases,

emergency preparedness and community health. Depending on the interviewee, the

survey took approximately 10 to 35 minutes to conduct. The surveys were translated into

Spanish and Portuguese. The survey was reviewed by a focus group and the CHA Data

Subcommittee.

The teams were provided with Capturx digital pens and answer sheets to record

the answers to the survey. The pens store the answers recorded on the digital paper and

when docked to the computer, automatically downloads into an excel spreadsheet and

ArcGIS program. The pens decreased the amount of time and number of errors associated

with inputting data manually.

The overall goal was to maintain communication, provide support to the

volunteers, retrieve epidemiological data, practice the CASPER protocol and have fun

while serving the Nashua community. Funding for this exercise was generously provided

by the New Hampshire Department of Health and Human Services, United States

Department of Health and Human Services/Centers for Disease Control, City of Nashua

DPH&CS, Nashua Area Health Center, Southern New Hampshire Medical Center and St.

Joseph’s Hospital.


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Exercise Objectives, Capabilities, and Activities

Capabilities-based planning allows for exercise planning teams 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 has

decided to demonstrate the following capabilities during this exercise:

Objective 1: To test our communications plan using landlines, cell phones, walkie talkies

and radios.

Communications: Alert & Dispatch; Provide Emergency Operations Center

Communications Support

Objective 2: To coordinate the health survey, allocate resources and maintain

communication.

Emergency Operations Center Management: Activate EOC/MACC/IOF; Identify

and Address Issues; and Provide EOC/MACC/IOF Connectivity.

Objective 3: To gather health data from 210 residents using the CDC’s CASPER

protocol and test the use of the Capturx pens for completing the answer sheets for the

survey and mapping walking paths on maps.

Epidemiology/Surveillance: Surveillance and Detection

Scenario Summary The health survey will help the DPH&CS collect information on health topics. For the

exercise, volunteers were recruited and trained according to the CASPER protocol to go

out into the community and gather this data. They attended an all day training the day

before the survey day that reviewed the survey questions, the protocol for interviewing

houses and apartment complexes, safety precautions, maintaining cultural competency in

working with diverse residents and more. On the day of the survey, volunteers convened

at Southern New Hampshire Medical Center (11/6 – St. Joseph Hospital) and were

provided the necessary equipment needed to conduct the surveys. Throughout the day,

volunteers communicated with the team leaders and support staff stationed at the

command post. From this post, the support staff coordinated the main communications,

operations and logistical functions to ensure the efficiency of the exercise.

Section 3: Analysis of Capabilities


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This section of the report reviews the performance of the exercised capabilities, activities,

and tasks. In this section, observations are organized by capability and associated

activities. The capabilities linked to the exercise objectives of Health Survey 2010 are

listed below, followed by corresponding activities. Each activity is followed by related

observations, which include references, analysis, and recommendations.

Capability 1: Communications

Capability Summary: Communications is the fundamental capability within disciplines

and jurisdictions that practitioners need to perform the most routine and basic elements of

their job functions. Agencies must be operable, meaning they possess sufficient wireless

communications capabilities to meet their daily internal and emergency communication

requirements before they focus on interoperability. For the Health Survey 2010 exercise,

the goal was to maintain communication between the volunteers and team leaders at the

command post.

Activity 1: Provide Emergency Operations Center Communications Support

Observation 1.1: Strength and Weakness

Analysis: The survey teams were able to contact their team leader or the command post

when needed using cell phones. During the survey, two way walkie talkie

communications were tested. As teams traveled further into various parts of the City, the

walkie talkies stopped working. However, due to cell phone use the teams were able to

contact their team leaders as the need arose. Teams were never unable to get in touch

with their team leaders or the command post.

Recommendations: Instead of using walkie talkies, utilize handheld radios.

Update: When teams returned to the field on November 6, 2010, the teams used

handheld radios instead of the walkie talkies which enhanced communications between

the teams, team leaders and the command post. The handheld radios worked throughout

the entire City and were more efficient.

Observation 1.2: Area for Improvement

Analysis: Throughout the course of the day there were a few survey teams that the team

leaders were not able to reach via walkie talkie or cell phone communications. Team

leaders were conducting status checks on teams that they had not heard from in some

time and were not able to get through via walkie talkie or cell phone. Eventually, they

were able to make contact with each team, however at one point a staff member had to go

into the field to track down the survey team. The survey teams explained they had shut

the ringer off on their phone or were in the middle of a survey and did not answer.


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Recommendations: Nashua DPH&CS should reinforce to the survey teams the

importance of the communications checks. One individual on each team should be

assigned as the communication lead and be responsible for answering calls from the

MACE and/or team leads.

Update: On November 6, 2010 when the teams returned to the field with the handheld

radios, communications were more efficient and it was easier for the teams to

communicate without interrupting the interviewees as they were answering questions.

Each team also assigned one person to wear and use the handheld radio while they were

in the field.


Analysis: In the latter part of the day as teams were making progress with their surveys,

they tended to be calling in all at the same time. Phone calls became overwhelming and

were not able to be answered and went to voicemail many times. While team leads were

trying to make outgoing calls to extend survey paths they became inundated with time

check calls from other teams. While survey extensions are important for team leads to

handle, simple calls such as time checks could be completed more efficiently by support

staff.

Recommendations: MACE team should have a bank of phones for the survey teams to

call into with support staff answering the calls. Any issues or concerns should be pushed

up to the team leads. Use of handheld radios may make this process more efficient.

Update: On November 6th

, 2010, teams were required to check in only after completing

their surveys and not when they both started and completed the survey. The coordinators

also extended the walk on the maps for each team prior to deployment. This significantly

decreased the number of calls coming in at once.

Capability 2: EOC Management Capability Summary: Emergency Operations Center (EOC) management is the

capability to provide multi-agency coordination (MAC) for incident management by

activating and operating an EOC for a pre-planned or no-notice event. EOC management

includes: EOC activation, notification, staffing, and deactivation; management, direction,

control, and coordination of response and recovery activities; coordination of efforts

among neighboring governments at each level and among local, regional, and State

partners.

Activity 2: Provide EOC/MACC/IOF Connectivity


Analysis: While setting up the MACE, staff was unable to log into the computer as the

“MACE”. It was discovered that the IT Department had disabled the MACE account on

the computer.


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Recommendations: Nashua DPHS&CS should have IT support on duty or on standby

during exercises and real world events to troubleshoot and solve IT issues. It would also

be beneficial to have the MACE account established with a password/account that does

not expire.

Activity 3: Identify and Address Issues


Analysis: Support staff sent into the field should be in teams of at least two. Some

support staff went to deliver lunch to the teams by themselves. To ensure safety, the

buddy system should be used.

Recommendations: For safety and efficiency purposes the MACE staff should ensure

that all teams that are sent into the field, regardless of task, are done so in a minimum of

two person teams.

Update: On November 6th

, support staff members were not sent out into the field alone.

Observation 3.3: Strength

Analysis: Issues that arose for survey teams were handled quickly and efficiently. Teams

ran into various issues throughout the day that required immediate decision making from

team leads and the MACE staff. Calls were taken immediately and issues were resolved

rather quickly. These situations did not delay the survey process and were handled very

well.

Recommendations: Continue open communication and pre-event education to survey

partners.

Capability 3: Epidemiological Surveillance and Investigation Capability Summary: The Epidemiological Surveillance and Investigation capability is

the capacity to rapidly conduct epidemiological investigations.

Activity: Surveillance and Detection


Analysis: Survey teams were efficient and friendly while conducting the surveys. Many

teams made it through their initial loop right before or immediately following their lunch

break. While many Nashua residents were not home or unavailable, the ones who did

participate in the survey welcomed the survey teams and were comfortable with their

presence in their homes.


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Recommendations: Continue training for teams regarding personal safety, education of

the survey needs and the goal of the program.


Analysis: There were two survey teams that had bilingual individuals on the team and

they were available throughout the day. Due to Nashua’s diverse population it is

imperative that individuals who are conducting the surveys on behalf of the city are able

to communicate with the residents and gather accurate information.

Recommendations: Recruit more multilingual survey team members to assist with the

survey process.

Other Strengths and Areas for Improvement:

Capability: Volunteer Management

Observation 4.1: Area of Improvement

Analysis: It was difficult for those staff members assisting with the registration of

volunteers to keep track of the necessary items and documents they needed to complete

before going out into the field (i.e. signed consent forms, photo waiver).

Recommendations: Have a checklist for staff managing volunteer registration to

improve efficiency.

Update: When teams returned to the field on November 6th

the support staff was

provided with a checklist to identify any missing documents or materials needed from the

volunteers to participate in the exercise. Registration was completed efficiently.


Analysis: It was challenging at times for the team leaders to keep track of all the

important details needed to guide the teams before and during the exercise.

Recommendations: Develop training and a checklist for the team leaders to be done

prior to the health assessment. This will allow them to provide important information and

reminders in an organized manner prior to the departure of teams.

Update: On 11/6, the team leaders had a checklist of important details and reminders to

review with their respective teams before their departure to the field. This allowed for

better organization and delivery of critical information.

Observation 4.3: Strength & Area of Improvement


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Analysis: The training conducted the Friday before the survey day was adequate. The

volunteers were equipped with knowledge about following the CASPER protocol, using

the Capturx pens, interacting with community members from different cultural

backgrounds and ensuring safety. Some volunteers would like to spend more time

reviewing the maps and using the pens prior to field deployment. However, the team

leaders felt they needed a separate training specifically on being a team leader where they

could talk about potential issues ahead of time.

Recommendations: Dedicate a larger portion of time to spend reviewing the maps and

pens during the training. Develop training and a just-in-time training for team leaders

that can be done prior to the general training for volunteers.


Analysis: There were several individuals that wanted to volunteer to participate in the

health assessment but were unable to make it to the training because of their schedules.

Recommendation: We can offer a training session at night for people that work during

the day.


Analysis: When teams were getting ready to begin their surveys, they grabbed the back

packs without realizing that each bag was numbered and associated to a team. The teams

were able to correct the situation and retrieve the appropriately numbered bag. Each bag

had the same equipment but it could have caused issues with accountability.

Recommendations: Nashua DPH&CS should clarify during the training that the bags are

numbered by team. Assign support staff to distribute the bags to the appropriate teams. A

sign out sheet would be beneficial to have as well.

Update: Before teams were sent out into the field on November 6th

support staff called

each team by number and handed them their appropriate back pack and had them sign out

the maps and hand held radios. This ensured that each team received the appropriate

assigned equipment.

Capability: Planning and Preparation Observation 5.1: Area of Improvement

Analysis: When conducting the surveys door-to-door, some teams encountered members

from the elderly populations who were afraid or anxious of them because they were

unaware of the exercise.

Recommendations: Explore ways to better communicate with the elderly community.


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Collaborate with organizations, such as the Senior Center, that provide services and

outreach to Nashua’s elderly to help inform these populations about the exercise.


Analysis: Most apartment complexes allowed us to conduct the survey on their premises.

However, there were some that did not allow us to do so. This prevented us from

gathering valuable epidemiological data from those neighborhoods.

Recommendation: We can contact these apartment complexes well in advance and try to

put the survey on the agenda of the board meetings to get their support. This will allow us

to fully explain the importance of having the data from their residents as part of the CHA.


Analysis: It takes a long time to print the answer sheets on digital paper for the survey.

Approximately 3.5 hours to print 250 answer sheets.

Recommendation: Have a generic survey answer template that can be used for a basic

survey and have them already printed out on a several copies of digital paper.


Analysis: Prior to the health survey on 10/23 and 11/6 the Health Specialist worked with

Division staff and the regional Media Advisory Group to alert residents to the health

survey. Flyers were created and distributed at apartment complexes, schools, and other

buildings of opportunity. A short PSA with the assistance of the Mayor was put together

and aired on Ch 16 and Ch 99. The Nashua School District sent a message via eNews to

parents and organizations from the Advisory Board shared the information with their

clients and staff. The Nashua Telegraph released an article on the health survey prior to

10/23 (the link can be found at http://www.nashuatelegraph.com/news/885476-

196/survey-takes-aim-at-health-needs.html).


Analysis: The volunteers wore red vests with name badges while in the field. This

provided credibility when interviewing residents. The team leaders also had copies of

their teams’ map and walking path. This allowed team leaders and support staff to locate

volunteers if needed and provided accountability of the volunteers.

http://www.nashuatelegraph.com/news/885476-196/survey-takes-aim-at-health-needs.html

http://www.nashuatelegraph.com/news/885476-196/survey-takes-aim-at-health-needs.html


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Section 4: Conclusion

Overall, the Health Survey 2010 exercise was a success. The volunteers were adequately

prepared and equipped to survey Nashua’s residents. They maintained communication

with the command post at critical points throughout the day, even when primary modes

of communication were non-functioning. At the command post, the support staff logged

and addressed important issues and volunteer needs. Important epidemiological data on

the health of Nashua was collected in a friendly, efficient and culturally competent

manner. Lessons learned for future exercises include expanding the communications

equipment so volunteers can remain connected to the command post and team leaders

even in remote areas, and better utilizing the Incident Command System. Many of these

areas for improvement were enhanced for our return to the field on November 6, 2010.

We have organized an After Action Conference for January 2011 to review the overall

results from this exercise and discuss strategies for improvement for future exercises.


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Appendix A: Improvement Plan

This IP has been developed specifically for the Greater Nashua Public Health Region and DPH&CS as a result of the Health Survey

2010 conducted on October 23, 2010 and November 6, 2010. These recommendations draw on both the After Action Report and the

After Action Conference. Note: The MACE stands for Multi-Agency Coordinating Entity and is synonymous with the Incident

Command Post or Emergency Operations Center.

#Capability Recommendation Corrective Action Description Responsible

Party Completion

Date

Communication Nashua DPH&CS should reinforce

to the survey teams the importance

of the communications checks. One

individual on each team should be

assigned as the communication lead

and be responsible for answering

calls from the MACE and/or team

leads.

On November 6, 2010, team

leaders reinforced that their teams

must check in with the command

post. Teams also used handheld

radios which functioned perfectly

in the field. This facilitated

immediate and efficient

communication with the command

post.

Exercise

Coordinator

11/6/10

MACE team should have a bank of

phones for the survey teams to call

into with support staff answering

the calls. Any issues or concerns

should be pushed up to the team

leads.

On November 6th

, 2010, teams

were required to check in after

completing their surveys and not

when they started the survey. The

coordinators also extended the

walk on the maps for each team.

This significantly decreased the

number of calls coming in at once.

Team

Leaders


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Look into Capturx Mobile

technology to assist in the

timeliness of the data and

accountability of volunteers

Regional

Public Health

Preparedness

Coordinator

EOC

Management

Nashua DPHS&CS should have IT

support on duty or on standby

during exercises and real world

events to troubleshoot and solve IT

issues. It would also be beneficial

to have the MACE account

established with a

password/account that does not

expire.

In November 2010, IT reactivated

the MACE account with an

account that will not expire.

Explore ways to contact IT 24

hours a day and during

emergencies. Add to MACE Plan.

Regional PH

Preparedness

Coordinator

11/2010

EOC

Management

For safety and efficiency purposes

the MACE staff should ensure that

all support staff and teams that are

sent into the field, are in two or

more person teams.

Add to the Volunteer Annex Regional PH

Preparedness

Coordinator

or Safety

Officer

Volunteer

Management

Nashua DPH&CS should clarify

during the training that the bags are

numbered by team. Assign support

staff to distribute the bags to the

appropriate teams. A sign out sheet

would be beneficial to have as well.

On November 6th

support staff

called each team by number and

handed them their appropriate

back pack and had them sign out

the maps and hand held radios.

This ensured that each team

received the appropriate assigned

equipment.

Team

Leaders

11/6/10

Volunteer Have a checklist for staff managing On November 6th

the support staff Support Staff 11/6/10


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Management volunteer registration to improve

efficiency.

was provided with a checklist to

identify any missing documents or

materials needed from the

volunteers to participate in the

exercise. Registration was

completed efficiently.

Develop a training targeted

specifically for the team leaders.

This training will review important

operational functions for the team

leaders which includes how to track

volunteer issues, how to use the

radios, etc.

Develop job action sheets for the

team leaders and support staff.

Project

Coordinator

and Team

Leaders

Develop training on how to debrief

teams before heading to the field

and a checklist for the team leaders

to keep track of important

reminders.

On November 6, team leaders had

a checklist of important details

and reminders to review with their

respective teams before their

departure to the field. This

allowed for better organization

and delivery of critical

information.

Exercise

Coordinators

11/6/10

Planning and

Preparation

Increase communication with those

from various populations (i.e eldery

Add to Risk Communication

Annex

Regional PH

Preparedness


~ 20 ~

and functional needs) to keep them

informed and encourage their

participation in the survey.

Collaborate with organizations that

provide services to them.

Coordinator

and the

Public

Information

Officer

Set up meetings with the apartment

complex board members to ask for

permission to survey the residents

of the complex. Collaborate with

other City agencies that my already

have a relationship with the board.

Regional PH

Preparedness

Coordinator

and the

Public

Information

Officer

Create a basic or generic survey

answer template to be printed on

digital paper ahead of time.

Exercise

Coordinator

Ensure that at least 3 people in the

Division understand how to

perform a rapid needs assessment

and can use the Capturx software.

Epidemiologi

st

Note: The following ideas will be kept in the mind for future exercises

1. Training sessions will be offered at alternate times to accommodate volunteers with various schedules.

2. Additional staff members will be trained to participate in operational exercises. This will allow them to be familiar with the

different positions and responsibilities and equip them to serve in any of the positions needed in the exercise.

3. Publicity for volunteer recruitment will be launched well in advance to encourage participation. Collaboration with the

technical schools and college may help with recruitment, as the school may consider integrating the exercise into their

programs.


~ 21 ~

Appendix B: Participant Feedback Summary

Community Health Survey Evaluations from October 23, 2010

Overall, the volunteers had a positive experience going out into the community and

conducting the survey. They felt the training was adequate for the exercise and they were

well received by the community. They acknowledge the difficulty in communicating with

the command post and their team leaders because the walkie talkies did not function at all

in all parts of the City. Refer to the below table for specific responses to the evaluations

for the health survey and for using the Capturx digital pens and Anoto digital paper.

Question Scale # of

responses (%)

1. Now that I have completed the survey process, I

think the training on Friday was adequate to prepare me

for the day of the survey. (n=30)

Strongly agree 1 23 (77%)

2 5 (17%)

3 1 (3%)

4 0 (0%)

Strongly disagree 5 1 (3%)

2. I had the necessary supplies to conduct the surveys in

the community. (n=30)


2 1 (3%)

3 0 (0%)

4 0 (0%)


3. The communication tools (e.g. radios and cell

phones) were in working condition, easy to use, and

adequate for communications during the survey

process. (n=29)


2 2 (7%)

3 8 (28%)

4 6 (21%)


4. The maps and walking paths were easy understand,

use and follow. (n=29)


2 2 (7%)

3 8 (3%)

4 6 (21%)



~ 22 ~

5. Overall, how were you perceived by the public while doing the survey?

“I was surprised that minorities were more willing to participate”

“Most people were accepting and welcoming. Others did not want to be bothered or thought we were

trying to talk about politics”

“Well”

“Good”

“Very well, interested to help out”

“Everyone we spoke to was aware of survey. Well received”

“Fine - most people willing to participate, some getting impatient by the end”

“The public was gracious and accepting, except for one person who was not hostile, but felt we might

be part of Obama administration or part of the health care policy that recently passed.”

“Fairly ambivalent”

“Overall Ok”

“Mostly the public was very receptive. No bad comments”

“Welcomed. [Most] expected us.”

“Very well”

“People were extremely receptive and apologized if they didn’t have time or were unable to take the

survey”

“No problems - typically neutral”

“I think we were perceived well by the public while doing the survey.”

“We were very well received in general - had one guy who was a little rude, but the doorbell woke

him up, so…We had 2-3 elderly folks and they all seemed a little nervous and declined to take the

survey”

“Some of them refused, some reason out that they are busy don’t have time to do interview”

“Very well for those who were home”

“Received well. ID’s and vests/name on vests helped show who we were”

“It varied. About half were interested and open and the other half were rushed and not interested”

“Overall, some were very helpful, but on the other hand some, especially ethnic groups refused to

participate”

“Ok I think. Some people didn’t have time”

“Very friendly, very willing - the unwilling were still nice”

“Generally, well received”

“Welcomed by people willing to participate. Many others were less “friendly”.”

“Overall good”

“They were happy they were helping the community”

“Well. Most people were friendly and glad to see us in the community”

“The only challenge was finding people who were at home and awake during the morning hours- got

much better in the afternoon. Had about as many decline to take the survey as there were participants.”


~ 23 ~

6. Comments & Suggestions: If you rated a statement as “strongly disagree” or “disagree”

please explain why.

“The radio didn’t work at all. We were able to use cell phones fine.”

“The radio was not working. Maps a little confusing.”

“There were a lot of materials to carry and juggle. Might be good to conduct on small hand held

computer.

Also ? use GPS and mark homes - already programmed - could get more done.”

“Great training for the task and adequate publicity”

“Radios did not work. Cell phones awkward at beginning of interview, so just called in at the end.”

“Walkies did not work well, needed to use cell phones. More help/time with maps and longer walking

route would

have been helpful.

“Radios worked only intermittently. The maps were very confusing and often inaccurate”

“Radios didn’t work well. Phone was awkward. The teams should be one Nashua and one volunteer.”

“Radios did not work at all. Recommend placing Nashua residents with non-Nashua residents”

“Walkie talkie radios did not work”

“Walkies did not function. Personal cell fine.”

“The radios were not a good source of communication because the reception was not good.”

“1. The training pretty well covered everything

2. Everything we needed was there and then some!

3. Radio reception was spotty, so we just used our cell phones.

4. Had one question about the route at the very beginning, but no problems other than that.”

“Possible make an early start like 9-9:30 am. Possible give another map for continuation if the map

finished.”

“Have a “mini” stretching exercise before going to the survey- I mean during the briefing prior to

survey-just for warmth up…”

“It was difficult in multi-unit homes. They weren’t “apartment complexes” but when you got to the

front door it was locked, so you couldn’t know on the actual apartment”

“The questions on survey in Spanish was not so clear, whoever translated should have it check by

someone else it was a lot of mistakes”

7. Would you like to be involved in future activities?

All 30 respondents replied “yes”.

“Elders who get scared when knocking at the door. One family - 1st refused but when we are leaving

they called us because they said they need help in their health insurance-so they like to participate…”

“Was a pleasant experience overall. No’s get disappoint but yes’s were exhilarating!”


~ 24 ~

Capturx Digital Pens and Anoto Digital Paper Evaluations

Question Scale # or

responses

1. How would you rate your overall experience with the pens? (n=21)

Poor 0 (0%)

Fair 1 (5%)

Satisfactory 5 (23%)

Good 11 (52%)

Excellent 4 (19)

2. How helpful was the training in preparing you for use of the pen? (n=22)

Not Helpful 0 (0%)

Somewhat

Helpful 0 (0%)

Helpful 9 (41%)

Very Helpful 13 (59%)

3. Did you experience any challenges? If so, what were they?

“No”

“Not always sure the pen was on”

“No”

“No”

“Keeping to move the paper for the legend is awkward.”

“No”

“None - worked very well”

“Cost of pen made me concerned about losing it. At times the pen felt like it didn’t vibrate after

opening it.

It vibrated when point was placed on paper.”

“Making the map (because houses were very small)”

“None”

“No”

4. Do you have any recommendations or additional comments?

“No challenges with the pen”

“No”

“No”

“The ink does not always flow well, need to know if we should retrace unclear lines like on the map

legend symbols.”

“None”

“It was a good experience.”

“Can’t think any, but if I do, I know where to find you!”

“Teaching us how to erase and fix errors.”


~ 25 ~

“A little more “hands on” with map and pen applications.”

“Took some time to develop routine for remembering to touch the icon before and after use.”

“No”

“No”

Community Health Survey Evaluations from November 6, 2010

Overall, the volunteers had a positive experience going back out into the community and

conducting the survey. They felt the training was adequate for the exercise; they were

well received by the community and had a lot of fun. Almost all volunteers noted that the

communications systems were adequate for the exercise. This validates that handheld

radios should be used for future exercises rather than walkie talkies.

Question Scale # of

responses (%)

1. Now that I have completed the survey process, I

think the training on Friday was adequate to prepare me

for the day of the survey. (n=18)


2 2 (11%)

3 1 (5%)

4 0 (0%)


2. I had the necessary supplies to conduct the surveys in

the community. (n=20)


2 1 (5%)

3 0 (0%)

4 0 (0%)


3. The communication tools (e.g. radios and cell

phones) were in working condition, easy to use, and

adequate for communications during the survey

process. (n=20)


2 3 (15%)

3 0 (0%)

4 0 (0%)


4. The maps and walking paths were easy understand,

use and follow. (n=20)


2 4 (20%)

3 4 (20%)

4 1 (5%)



~ 26 ~

5. Overall, how were you perceived by the public while doing the survey?

“Some were aware of this project by the media. Some had to be “talked into” doing the survey. Many

were not home - disappointing.”

“Very well.”

“Some residents were skeptical of us in spite of our identification, etc. On the most part, people were

receptive.”

“I think we were perceived well”

“Most individuals were compliant or reasonably easy to persuade”

“Cooperative/friendly”

“Friendly and approachable”

“Well”

“Very good. Very welcome”

“Very well”

“Everyone was very nice and most were willing”

“Overall I think the public respected and participated us as a member of Nashua Public Health”

“Very well”

“The public was welcoming”

“Well overall. One person refused because he felt the survey would not be confidential”

“The most of the people were kind and nice”

“Well received by all household but one who seemed to be having a bad day, not related to our

interruption in her day. We did have a couple stop to inquire about our activity, and express very

negative feelings with lack of actions taken in the community re existing negative problems i.e. bed

bug infection problems, also lack of services for drug addicts etc.”

“Generally we were positively accepted by the community although there’s few who don’t want to

participate and there’s one we encountered that have very bad experience with public health and

thought that she can’t have any solution with City’s problem.

“It was okay. The walk was long but it was fun to meet people.”

“We were well received by those who were willing to take the survey. Otherwise my location wasn’t

very receptive and closed the door in our faces.”

“Sometimes discouraged by the rejection.”

6. Comments & Suggestions: If you rated a statement as “strongly disagree” or “disagree”

please explain.

“Great Preparation, planning, execution of surveys. Wonderful PH staff - Ashley and Debbie…deeply

appreciated this opportunity to serve. Thanks!”

“I had trouble understanding the maps - luckily my partners was able to read them.”

“#’s and roads not there”

“Excellent experience - maps not always accurate.”

“Everything was well thought out”

“I think that this was a great experience and everything was well put together.”

“The maps wasn’t clear about some houses that we haven’t to visit”

“Program was very well organized. Details left nothing to be missed - easy to follow.”


~ 27 ~

7. Would you like to be involved in future activities?

18 out of 20 volunteers responded “yes”.

“We need to do it again in a regular basis and hope we can find solutions to our community problem”


~ 28 ~

Appendix C: Exercise Events Summary Table

Table 1: Health Survey 2010; 10-23-10 Events Summary

Date Time Event/Action

10/23/10 0700 Division CHA Team Arrives for set-up at SNHMC

10/23/10 0800 Volunteers sign-in and get equipment

10/23/10 0830 Review key points make sure everyone has their maps, surveys,

etc.

10/23/10 0930 Teams leave SNHMC and go to their first neighborhood

10/23/10 1000 Teams arrive at their first house

10/23/10 1140 Support staff/drivers take lunch out to the teams

10/23/10 1200 Teams take a 30 minute lunch (mandatory)

As teams finish, they report back to the DPH&CS

10/23/10 1600 All teams must report back to DPH&CS

10/23/10 1615 Wrap-up/Hotwash


~ 29 ~

Table 2: Health Survey 2010; 11-6-10 Events Summary

Date Time Event/Action

11/6/10 0700 Division CHA Team Arrives for set-up at SJH

11/6/10 0800 Volunteers sign-in and get equipment

11/6/10 0830 Review key points make sure everyone has their maps, surveys,

etc.

11/6/10 0930 Teams leave SJH and go to their first neighborhood

11/6/10 1000 Teams arrive at their first house

11/6/10 1200 Teams take a 30 minute lunch out in the field (mandatory)

Lunch was provided to teams before departure in thermal

lunchboxes.

11/6/10 1600 All teams must report back to DPH&CS

11/6/10 1615 Wrap-up/Hotwash


~ 30 ~

Appendix D: Acronyms

Table 3: Acronyms

Acronym Meaning

CASPER Community Assessment for Public Health Emergency Response

CHA Community Health Assessment

CDC Centers for Disease Control and Prevention

DPH&CS City of Nashua Division of Public Health & Community Services

EOC Emergency Operations Center

IOF Initial Operating Facility

JIT Just-in-Time Training

JFO Joint Field Offices

JOC Joint Operations Center

MACE Multi-Agency Coordinating Entity

MACC Multi-Agency Coordination Center

NOC National Operating Center

NRCC or (RRCC) National (or Regional) Response Coordination Center

RNA Rapid Needs Assessment

SNHMC Southern New Hampshire Medical Center

SJH St. Joseph’s Hospital

.


~ 31 ~

Appendix E: THANK YOU TO OUR

VOLUNTEERS!!!

American Red Cross

Ashley Pushkarewicz

City of Nashua, DPH&CS

Victoria Alabi

Mike Amichetti

Theresa Calope

Ashley Conley

Patty Crooker

Debbie Daniels

Corinn Dembkoski

Janet Graziano

Sue LaPointe

Meredith Lyons

Al Matkowsky

Sandy Mulcahy

Luis Porres

Howard Price

Barbara Scacco

Kerran Vigroux

Betty Wendt

Community Members

Jim Dembkoski

Linda Fielding

Dartmouth-Hitchcock

Tracy Bennett

Lorraine Schreib

Gateways Community Services

Kristen Leppanen

Jo-Ann Sheehan

Greater Derry Medical Reserve Corps

Maria Rocheleau

Greater Nashua Mental Health Center at Community Council

Joan Haskell

Jennifer McGrath

Hillsborough County Amateur Radio Emergency Services

Jim Blaine


Mariellen Durso

Mara Lessard

Justine Nims-Largy

Maria Cecilia Pereira

Janice Watson


~ 32 ~

Nashua Community College

Emma DeLosAngeles

Angela Mercado

Tresa Ann O'Connor

Nashua Police Athletic League

Leah Nora Chauvin

Nashua Police Department

Ed Lecius

NH Dept. Health & Human Services

Adnela Alic

Rick Cricenti

Melissa Gravilla

Deborah LaFave

Darlene Morse

Carole Totzkay

Sandy Weld

NH HSEM

Fallon Reed

Rivier College

Sandra Harrington

Elizabeth Kilar

Susan Mika

Edlie Rivas

Danielle Spinhirn

Sarah Stauff

Kristen Tyler

Emily Veloso

Southern NH Medical Center

Mark Hastings

Southern NH Services

Amy Moutenot

St. Joseph Hospital

Fran Dupuis

St. Louis De Gonzague Parish

Carmen Dussault


~ 33 ~

Pictures from the Health Survey


~ 34 ~

Documents

AFTER ACTION REPORT/IMPROVEMENT PLAN...2010/01/07 · Homeland Security Exercise and Evaluation Program (HSEEP) After Action Report/Improvement Plan Health Survey 2010 ~ 2 ~ Administrative