Full-scale regional exercises: Closing the gaps in disaster preparedness.

BACKGROUND: Man-made (9/11) and natural (Hurricane Katrina) disasters have enlightened the medical community regarding the importance of

Situation where widespread human, material, economic or environmental losses have occurred which exceeded the ability of the affected organisation, community or society to respond and recover using its own resources.

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The knowledge and capacities developed by governments, professional response and recovery organizations, communities and individuals to effectively anticipate, respond to, and recover from, the impacts of likely, imminent or current disasters.

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. In

Actions taken during or immediately after a disaster in order to save lives, reduce health impacts, ensure public safety and meet the basic subsistence needs of the people affected.

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to Joint Commission requirements, medical centers should have established protocols in place to respond to such events. We examined a full-scale regional

Process to train for, assess, practise and improve performance in an organization.
Note 1 to entry: Exercises can be used for validating policies, plans, procedures, training , equipment, and inter-organizational agreements; clarifying and training personnel in roles and responsibilities; improving inter­organizational coordination and communications; identifying gaps in resources; improving individual performance and identifying opportunities for improvement; and a controlled opportunity to practise improvisation.
Note 2 to entry: See also test.

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(FSRE) to identify gaps in logistics and operations during a simulated mass casualty incident. METHODS: A multiagency, multijurisdictional, multidisciplinary Process to train for, assess, practise and improve performance in an organization. Note 1 to entry: Exercises can be used for validating policies, plans, procedures, training , equipment, and inter-organizational agreements; clarifying and training personnel in roles and responsibilities; improving inter­organizational coordination and communications; identifying gaps in resources; improving individual performance and identifying opportunities for improvement; and a controlled opportunity to practise improvisation. Note 2 to entry: See also test.

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(FSRE) included 16 area hospitals and one American College of Surgeons-verified Level I trauma center (TC). The

Pre-planned storyline that drives an exercise, as well as the stimuli used to achieve exercise project performance objectives.

DRIVER+ note 1: In the context of DRIVER+ scenarios are defined for Trials not for exercises.

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simulated a train derailment and chemical spill 20 miles from the TC using 281 moulaged volunteers. Third-party contracted evaluators assessed each hospital in five areas: communications, command structure, decontamination, staffing, and patient tracking. Further analysis examined logistic and operational deficiencies. RESULTS: None of the 16 hospitals were compliant in all five areas. Mean hospital compliance was 1.9 (±0.9 SD) areas. One hospital, unable to participate because of an air conditioner outage, was deemed 0% compliant. The most common deficiency was communications (15 of 16 hospitals [94%]; State Medical Asset Resource Tracking

A device, equipment or piece of software used to carry out a particular process or procedure.

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system deficiencies, lack of working knowledge of Voice The ability of diverse systems and organisations to work together, i.e. to interoperate.

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Plan for

Sudden, urgent, usually unexpected occurrence or event requiring immediate action.
Note 1 to entry: An emergency is usually a disruption or condition that can often be anticipated or prepared for, but seldom exactly foreseen.

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Responders radio system) followed by deficient decontamination in 12 (75%). Other deficiencies included inadequate staffing based on predetermined protocols in 10 hospitals (63%), suboptimal command structure in 9 (56%), and patient tracking deficiencies in 5 (31%). An additional 11 operational and 5 logistic failures were identified. The TC showed an appropriate command structure but was deficient in four of five categories, with understaffing and a decontamination leak into the Sudden, urgent, usually unexpected occurrence or event requiring immediate action. Note 1 to entry: An emergency is usually a disruption or condition that can often be anticipated or prepared for, but seldom exactly foreseen.

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department, which required diversion of 70 patients. CONCLUSION: Communication remains a significant

Difference between the existing capabilities of responders and what was actually needed for effective and timely response.

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in the mass casualty Pre-planned storyline that drives an exercise, as well as the stimuli used to achieve exercise project performance objectives. DRIVER+ note 1: In the context of DRIVER+ scenarios are defined for Trials not for exercises.

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10 years after 9/11. Our findings demonstrate that tabletop exercises are inadequate to expose operational and logistic gaps in Situation where widespread human, material, economic or environmental losses have occurred which exceeded the ability of the affected organisation, community or society to respond and recover using its own resources.

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Actions taken during or immediately after a disaster in order to save lives, reduce health impacts, ensure public safety and meet the basic subsistence needs of the people affected.

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. FSREs should be routinely performed to adequately prepare for catastrophic events.