SCHEART Drills and Exercises
There are four phases in emergency management that comprise an "all-hazards" approach. The four phases are: mitigation, preparedness, response, and recovery.
- Mitigation activities, according to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), are those that "a hospital undertakes in attempting to lessen the severity and impact of a potential emergency." 1
- Preparedness activities are those that "a hospital undertakes to build capacity and identify resources that may be used if an emergency occurs." 2
- Response involves activating the plan (including the incident command system, or ICS) and dealing with the actual event as it unfolds. In health care facilities, it usually involves treating victims of the emergency.
- Recovery involves activities designed to help facilities resume operations after an emergency. 3
Drills and exercises should ideally test as many of the four phases of emergency management as possible, although they may not necessarily test them all at the same time.
Before designing and undertaking drills and exercises, planners at the state, regional, local, and/or agency level must have their emergency management plans in order. These plans are based on Hazard Vulnerability Analyses (HVA). The purpose of the HVA is to identify potential emergencies that could "affect the need for its services or its ability to provide those services." 4
Types of Drills and Exercises
Drills and exercises are based on possible real-life scenarios in order to improve emergency management’s preparation for emergencies of all kinds. There are several different types of drills and exercises.
Drill:
A drill is a supervised activity with a limited focus to test a procedure that is a component of the organization’s overall emergency management plan. That is, drills usually highlight and closely examine a limited portion of the overall emergency management plan. For example, an organization might conduct a drill for the use of a radio system with those responsible for communicating on it.
Tabletop Exercise:
A tabletop exercise uses written and verbal scenarios to evaluate the effectiveness of an organization’s emergency management plan and procedures and to highlight issues of coordination and assignment of responsibilities. Tabletop exercises do not physically simulate specific events, do not utilize equipment, and do not deploy resources. In a tabletop exercise, a facilitator usually coordinates discussion.
Functional Exercise:
A functional exercise simulates a disaster in the most realistic manner possible without moving real people or equipment to a real site. A functional exercise utilizes a carefully designed and scripted scenario, with timed messages and communications between players and simulators. The emergency operations center (EOC)—the facility or area from which disaster response is coordinated—is usually activated during a functional exercise and actual communications equipment may be used.
Full-Scale Exercise, or Field Exercise:
A full-scale exercise is often the final phase after previous drills and exercises. It tests the mobilization of all or as many as possible of the response components, takes place in "real time," employs real equipment, and tests several emergency functions. In the hospital context, a full-scale exercise often involves pre-hospital as well as hospital response, and usually involves actors simulating patients and the activation of the EOC. It may also include other health care facilities in order to test mutual aid agreements.
Hospitals that are accredited by JCAHO are required by JCAHO Environment of Care (E.C.) standard 4.20 to conduct drills regularly to test emergency management. Further, the "elements of performance" for E.C. 4.20 include the following:
- Hospitals must test the response phase of their emergency management plans twice a year, either in response to an actual emergency or in planned drills.
- Drills that involve "packages of information that simulate patients, their families, and the public are acceptable."
- Hospitals must conduct drills at least four months apart and no more than eight months apart.
- Hospitals must conduct at least one drill a year that includes an influx of volunteers or simulated patients if the hospitals offer emergency services or are "community-designated disaster receiving stations." For purposes of the "influx of simulated patients" requirement, tabletop exercises are not acceptable.
- Hospitals must participate in at least one communitywide practice drill a year (where applicable) relevant to the priority emergencies identified in their HVAs. The drill must assess the communication, coordination, and effectiveness of the hospital's and community’s command structures and may be conducted by means of a tabletop exercise.' "Communitywide" may range from a "contiguous geographic area served by the same health care providers to a large borough, town, city, or region."
- The drill involving the influx of volunteers may be separate, simultaneous, or combined with the communitywide practice drill.
- Drills must be critiqued to identify deficiencies and opportunities for improvement.
1. Joint Commission on Accreditation of Health Care Organizations, 2004 Comprehensive Accreditation Manual for Hospitals, Environment of Care Standard 4.10 (Oakbrook Terrace, Ill., 2004).
2. Ibid.
3. Ibid.
4. Ibid.
