2012
Source Material from CCALAC, LAC EMSA, & Constant and Associates

INTRODUCTION
This section provides a brief overview of the process of planning, conducting, and evaluating exercises. It is not intended to act as a substitute for formal exercise training and education, but is to provide a common framework of exercise program management to exercise planners.
Successfully conducting an exercise involves considerable coordination among participating staff. Before your clinic conducts an exercise, the appropriate senior executives and managers should be briefed to gain their support. Establishing this base of support indicates that the exercise purpose and objectives are concurrent with strategic clinic goals and objectives. Additionally, senior management often has the ability to garner participation from potential exercise players and planning team members.
PROGRAM MANAGEMENT
Exercise program management is the act of overseeing a variety of individual exercises and supporting activities sustained over time. An effective exercise program helps maximize efficiency, resources, time, and funding by ensuring that individual exercises are part of a coordinated, integrated approach to building, maintaining, and delivering core capabilities. Key elements of exercise program management include:
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Exercise Program Objectives. An exercise program should be guided by a set of overarching exercise program objectives linked to core capabilities. These overarching objectives can inform the development of exercise-specific objectives, ensuring that individual exercises build and maintain core capabilities in a coordinated and integrated fashion.
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Multiyear Training and Exercise Plan (TEP). A TEP aligns training and exercise objectives and schedules, encouraging clinic facilities to coordinate efforts to validate, assess, and enhance core operational capabilities.
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Corrective Action Process. A critical output of any exercise is the After Action Report, which defines and assigns corrective actions needed to address issues observed during exercise evaluation. Clinics are encouraged to track progress on all corrective actions, releasing periodic reports that document progress in resolving corrective actions and highlighting those corrective actions that are incomplete or behind schedule.
DESIGN AND DEVELOPMENT
The exercise design and development process builds on exercise program management to select participants for an exercise planning team, schedule planning conferences, identify and develop exercise- specific objectives and scope, design the scenario, create documentation, plan exercise conduct, select a focus for evaluation, and coordinate logistics.
E XERCISE P LANNING T EAM
A Clinic’s disaster response Incident Management Team (IMT) is the ideal committee to manage all aspects of an individual exercise to include exercise design, development, conduct and evaluation.
An effective IMT works with staff to determine or refine exercise objectives based on core clinical service and business operation capabilities. The scenario should be tailored to adequately test the facilities objectives and develop supporting documentation to guide exercise conduct and evaluation. IMT members should also help with developing and distributing pre-exercise materials and conducting exercise planning conferences, briefings, and training sessions.
For more information on Clinic Incident Management Teams consult the
“Community Clinic Guide to Disaster Response Incident Management Team Development.”

EXERCISE PLANNING ACTIVITIES
Effective exercise design and development involves a combination of exercise planning activities, often in the form of planning meetings and conferences. These planning activities bring together clinic staff to discuss and agree on key aspects of the exercise’s design and development.
The Exercise Planning Team should decide the type and number of planning activities needed to successfully plan a given exercise, based on its scope, type and relative complexity. For example, exercise planners generally employ longer timelines for tabletops than for workshops and seminars.
The following describes the types of planning meetings most useful in exercise design and development:
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Concept and Objectives (C&O) meeting. A C&O meeting is the formal beginning of the planning process.
It is held to identify the type, scope, objectives, and purpose of the exercise. For less complex exercises and for organizations with limited resources, the C&O meeting can be conducted in conjunction with the Initial
Planning Conference (IPC). Representatives the exercise planning team and senior staff typically attend the
C&O meeting. To identify the capabilities and tasks that are going to be assessed, design objectives based on those capabilities and tasks, and identify additional exercise planning team members.
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Initial Planning Conference. regardless of whether a C&O meeting is held, an IPC should be conducted for all exercises. Its purpose is to determine exercise scope by gathering input from the exercise planning team; design requirements and conditions (e.g., assumptions and artificialities); objectives; extent of play; and scenario variables (e.g., time, location, hazard selection). The IPC is also used to develop exercise documentation by obtaining the planning team’s input on exercise location, schedule, duration, and other relevant details. During the IPC, planning team members are assigned responsibility for activities associated with designing and developing exercise documents —such as the EXPLAN and the SITMAN—and logistics.
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Mid-Term Planning Conference (MPC). MPCs are typically used in more complex exercises to provide additional opportunities to settle logistical and organizational issues such as exercise organization and staffing concepts, scenario and timeline development, scheduling, logistics, and administrative requirements.
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Master Scenario Events List Meeting. The MSEL Conference focuses on developing the MSEL. The
MSEL is a chronological list that supplements the exercise scenario with event synopses; expected participant responses; capabilities, tasks, and objectives to be addressed; and responsible personnel. It includes specific scenario events (or injects ) that prompt players to implement the plans, policies, procedures, and protocols that require testing during the exercise, as identified in the capabilities-based planning process. It also records the methods that will be used to provide the injects (e.g., phone call, radio call, e-mail).
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Final Planning Conference. The FPC is the final forum for reviewing exercise processes and procedures.
An FPC should be conducted for all exercises to ensure that all elements of the exercise are ready for conduct. Prior to the FPC, the exercise planning team receives final drafts of all exercise materials. No major changes to the exercise’s design, scope, or supporting documentation should take place at or following the
FPC. The FPC ensures that all logistical requirements have been met, outstanding issues have been identified and resolved, and exercise products are ready for printing.

SIMPLE, MEASURABLE, ACHIEVABLE, REALISTIC, AND TASK-ORIENTED
(SMART) OBJECTIVES
The cornerstone of exercise design is the selection of capabilities to be assessed and determination of exercise objectives based on those capabilities. The exercise planning team determines core capabilities and objectives based on the overall exercise program objectives. The objectives should reflect the clinic ’s specific needs, environment, plans, and procedures, while providing a framework for scenario development and a basis for evaluation. Exercise planners should create objectives that SMART.
The Federal Emergency Management Agency
3
(FEMA), defines SMART objectives as:
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Simple: the objective is clearly written and simply phrased. It is brief and easy to understand.
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Measurable: the objective should set the level of performance, so that results are observable, and you can tell when the objective has been achieved. It does not necessitate a quantifiable standard, but completion of objective is easily demonstrated.
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Achievable: achieving it should be within the resources that the organization is able to commit to an exercise.
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Realistic: The objective should present a realistic expectation for the situation. Even though an objective might be achievable, it might not be realistic for the exercise.
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Task Oriented: The objective should focus on a behavior or procedure. With respect to exercise design, each objective should focus on an individual emergency function. Generally, planners should limit the number of exercise objectives to enable timely exercise conduct, facilitate reasonable scenario design, and support successful evaluation. Capabilities, tasks, and objectives are initially prepared during a C&O meeting or IPC.
For seminars, workshops, TTXs and games, objectives typically focus on strategic, policy-oriented issues; whereas for drills, FEs and FSEs, objectives typically focus on operational issues.
Exercise Design Steps: www.training.fema.gov/emiweb
Sample SMART Objective Flow into Exercise Actions:

EXERCISE SCOPE
Determining exercise scope enables planners to “right-size” an exercise to meet the objectives while staying within the resource and personnel constraints.. Key elements in defining exercise scope include exercise type, participation level, exercise duration, exercise location, and exercise parameters. Some of these elements are determined, or initially discussed, through program management activities. However, the exercise planning team finalizes the scope based on the individual exercise objectives. Alterations to the scope are reviewed with the exercise objectives in mind; planners must consider whether a change in the scope will improve or impede the ability of players to meet the objectives.
The following are exercise types to be tailored per the exercise objectives:
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Seminars. Seminars generally orient participants to, or provide an overview of, authorities, strategies, plans, policies, procedures, protocols, resources, concepts, and ideas. As a discussion-based session, seminars can be valuable for clinics that are developing or making major changes to existing plans or procedures.
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Workshops. Although similar to seminars, workshops differ in two important aspects: participant interaction is increased, and the focus is placed on achieving or building a product. Effective workshops entail the broadest attendance by relevant stakeholders. Products produced from a workshop can include new standard operating procedures, emergency operations plans, continuity of operations plans, and mutual aid agreements.
To be effective, workshops should focus on a specific issue, and the desired outcome, product, or goal must be clearly defined.
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Tabletop Exercises. A TTX is typically held in an informal setting intended to generate discussion of various issues regarding a hypothetical, simulated emergency. TTXs can be used to enhance general awareness, validate plans and procedures, rehearse concepts, and/or assess the types of systems needed to guide the prevention of, protection from, mitigation of, response to, and recovery from a defined incident. Generally,
TTXs are aimed at facilitating conceptual understanding, identifying strengths and areas for improvement, and/or achieving changes in attitudes. During a TTX, players are encouraged to discuss issues in depth, collaboratively examining areas of concern and solving problems. During a TTX, all participants should be encouraged to contribute to the discussion and be reminded they are making decisions in a no-fault environment. Effective TTX facilitation is critical to keeping participants focused on exercise objectives.
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Games. A game is a simulation of operations that often involves two or more teams, usually in a competitive environment, using rules, data, and procedures designed to depict an actual or hypothetic situation. Games explore the consequences of player decisions and actions and are therefore excellent tools to use when validating or reinforcing procedures or evaluating resource requirements.
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Drills. A drill is a coordinated, supervised activity usually employed to validate a specific operation or function in a clinic. Drills are commonly used to provide training on new equipment, validate procedures, or practice and maintain current skills. For example, drills may be appropriate for the testing of an evacuation plan, disaster triage process, or utilities outage response plan. Drills help determine if plans can be executed as designed, to assess whether more training is required, or to reinforce best practices.
For every drill, clearly defined plans, procedures, and protocols need to be in place. Personnel need to be familiar with those plans and trained in the processes and procedures to be drilled.
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Functional Exercises. FEs are designed to validate and evaluate capabilities, multiple functions and/or subfunctions, or interdependent groups of functions. FEs are typically focused on exercising plans, policies, procedures, and staff members involved in management, direction, command, and control functions. An FE is conducted in a realistic, real-time environment; however, movement of personnel and equipment is usually simulated.
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Full-Scale Exercises. FSEs are typically the most complex and resource-intensive type of exercise. They involve multiple agencies, organizations, and jurisdictions and validate many facets of preparedness. FSEs

often include many players operating under cooperative systems such as the Incident Command System
(ICS). FSEs are usually conducted in a real-time, stressful environment intended to mirror a real incident.
SCENARIO
A scenario is an outline of the simulated sequence of events for the exercise. It can be written as a narrative or depicted by an event timeline.
Exercise planners should select and develop scenarios that enable an exercise to meet its capabilities, tasks, and objectives. There are a number of factors that should be taken into consideration when developing a scenario, including level of realism, type of threat/hazard, site selection, weather variables, and optimal date and time for exercise conduct. All scenarios should be realistic, plausible, and challenging; however, designers must ensure the scenario is not so complicated that it overwhelms players. Scenario development should also take into account the capabilities and tasks that an exercise seeks to validate.
EXERCISE DOCUMENTATION
Thorough exercise documentation is a critical component of effective exercises. There is a range of exercise documentation available to planners. Factors such as exercise scope, type, and complexity inform the types of documentation needed. The list below briefly describes the various types of documents associated with most exercises. These documents should be customized to each clinic’s specific exercise.
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Situation Manual. SITMANs are provided as the core documentation that provides the textual background for an exercise. The SITMAN supports the acts as the primary reference for all participants during play.
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Exercise Plan. EXPLANs are general information documents that help large exercises run smoothly by providing participants with a synopsis of the exercise. In addition to addressing exercise objectives and scope,
EXPLANs assign activities and responsibilities for exercise planning, conduct, and evaluation. The EXPLAN is intended to be seen by the exercise players and observers
—therefore, it does not contain detailed scenario information that may reduce the realism of the exercise.
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Facilitator Guide. A Facilitator’s Guide is designed to help facilitators manage a seminar, workshop, TTX, game, or planning meeting. It usually outlines instructions and key issues for discussion during the event and provides background information to help the facilitator answer questions from participants or players. Many small clinic exercises do not have Facilitator Guides.
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Controller/Evaluator Handbook. The C/E Handbook describes the roles and responsibilities of exercise controllers and evaluators and the procedures they should follow. Because the C/E Handbook contains information about the scenario and about exercise administration, it is distributed to only those individuals specifically designated as controllers or evaluators. C/E Handbooks are usually provided only for very large exercises.
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Master Scenario Events List. A MSEL is typically used in exercises that involve many players, the use of patients (real or paper), or require the prompting of response staff who do not know the scenario details.. The
MSEL is a chronological timeline of expected actions and scripted events (i.e., injects) to be inserted into operations-based exercise play by controllers in order to generate or prompt player activity. It ensures necessary events happen so that all exercise objectives are met.
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Exercise Evaluation Guides. EEGs collect exercise observations and are aligned to a core capability and applicable performance objective, providing guidance on assessing capabilities being validated by the exercise. They are intended to guide an evaluator's observations of capabilities and tasks relevant to exercise objectives to create an after action plan.
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Participant Feedback Form. Players and observers should receive a Participant Feedback Form after the end of the exercise that asks for input regarding observed strengths and areas for improvement.
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After Action Report/Improvement Plan. The AAR/IP is the final product of an exercise. The AAR/IP has two components: an AAR, which captures observations and recommendations based on the exercise

objectives as associated with the capabilities and tasks and an IP, which identifies specific corrective actions, assigns them to responsible parties, and establishes targets for their completion.
EXERCISE CONDUCT
After design and development activities are complete, the exercise is ready to take place. Exercise conduct involves activities such as preparing for exercise play, managing exercise play, and conducting immediate exercise wrap-up activities. For a seminar, workshop, TTX or game, conduct also entails presentation, facilitation, and discussion. For a drill, FE or FSE, conduct encompasses all operations occurring between the designated start of the exercise (StartEx) and end of the exercise (EndEx). Core elements of exercise conduct include preparing for exercise play, conducting the exercise, and wrap-up.
L
OGISTICS
P
LANNING
Effective logistics are essential to a successful exercise. They can make the difference between a smooth, seamless exercise and one that is confusing and ineffective. Exercise planners should consider the full range of logistics related issues, such as venue layout and capabilities, access to restrooms, food and refreshments, badging and identification, parking.
E XERCISE P LAY P REPARATION
S ET U P
Immediately prior to exercise play, exercise planners conduct a series of activities to prepare for exercise play.
These activities include finalizing venue-related setup and confirming important venue- or exercise-specific logistical details. The exercise planning team should arrange and begin event setup as many days prior to the event as necessary, depending on the scope of the simulated environment. Setup entails arranging any briefing or exercise related rooms needed, testing audio/visual equipment, placing props and effects, marking the appropriate areas and their perimeters, and checking for potential safety issues.
On the day of the exercise, planning team members should arrive several hours before the scheduled start to handle any remaining logistical or administrative items pertaining to setup and to arrange for registration and conduct a communications check if necessary.
B RIEFINGS
Presentations and briefings are important tools for delivering necessary exercise-related information to participants on their roles and responsibilities prior to an Exercise. Exercise planners hold a series of briefings targeted to different types of exercise participants (e.g., controllers, evaluators, players). These briefings are an opportunity to distribute exercise documentation, provide necessary instructions and administrative information, and answer any outstanding questions prior to exercise play beginning.

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http://ems.dhs.lacounty.gov/Disaster/Announcement.htm

Provide an opportunity to exercise primary and redundant communication links between clinics, the
Community Clinic Association of Los Angeles County and the LAC DHS DOC.
Test the clinics’ ability to alert and notify personnel of the activation of the facility’s Emergency Operations
Plan.
Test the clinics’ ability to establish and maintain communications with internal Incident Management Team personnel.
Provide an opportunity for clinics to exercise mass fatality management plans and strategies to ensure that facility level plans are integrated into the OA’s plans for disposition of the deceased.
Provide an opportunity for clinics to exercise existing medical evacuation/shelter in place plans to ensure safety of patients, family members, and facility personnel.
Test clinics’ decision-making process of whether to evacuate or shelter in place.
Test the ability to conduct patient tracking during emergency response.
Test the ability to provide situation status to all response and partner agencies.
Test the ability of the clinic and the Incident Management Team to activate a medical surge plan.
Provide an opportunity for clinics to exercise multi-casualty/mass casualty patient management, movement, and tracking processes.
Test the ability of the Incident Commander to activate the Emergency Operations Plan upon event notification.
Test the ability to sustain operations and provide patient care services in response to a loss of community power source.

Site Location
Staffing Designations
Exercise Participants
Contact Position/Title
Contact
Contact
Contact
Contact
Contact
Position/Title
Position/Title
Position/Title
Position/Title
Position/Title
Play Coordination
Contact
Evaluation
Contact
Position/Title
Position/Title
Other
Contact Position/Title
Contact
Facilities Requirements/Play Locations
Materials/Resources Requirements
Position/Title
Communications / Notifications Systems to be Exercised
 Everbridge  Reddinet  Phone Tree  Email Distribution List  Overhead PA  CAHAN  other________
Target Capabilities to be Exercised
Communications
 Determine/evaluate the clinic’s ability to communicate with Health Care response partners
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Discuss/test the ability to communicate needs to outside sources/vendors/utilities/city
Intel/Info. Dissemination
 Review/test ability to gather situational information & share information internally
 Review/test plans for disseminating messages to internal (staff) & external (patients/community) populations
 Discuss/test ability to provide situational status and projected impact on service provision to local authorities
Medical Surge

Determine/evaluate ability to expand capacity utilizing non-traditional patient care areas
 Determine/evaluate ability to prioritize, manage, and allocate resources internally and through Mutual Aid assistance
 Discuss/test capacity to provide care without water
Emergency Ops Mgmt
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Review/test Emergency Operations Plan and hazard specific annex as applicable
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Discuss/exercise ability to activate the command center and initiate incident action planning for response & recovery
Number of Patients: ____Paper / ____Actual
( Patient Profiles & Additional Resources: http://ems.dhs.lacounty.gov/Disaster/Announcement.htm
)

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Does your Emergency Management Plan Address the following issues?
Mitigation & Preparedness
1.
Does your clinic Emergency Management Plan include triggers or criteria for activation of the Emergency Operations plan and the Clinic Command Center?
2.
Does your clinic have procedures to:
 Verify all emergency generators start and are accommodating the clinic’s emergency power load?
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Verify that the exhaust fans and air handlers supplied by emergency power are operating?
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Evaluate verify that only essential equipment is plugged into emergency power outlets throughout the facility?
 Contact the utility company’s operations center to ascertain scope and length of service interruption?
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Evaluate critical areas to determine emergency power needs and supply; provide alternative light sources
(i.e., battery powered lights, flashlights)?
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Acquire generator fuel and needed repairs to maintain emergency power?
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Prioritize emergency power allocation to critical infrastructure (i.e., HVAC units, morgue, elevators, patient monitors, ventilators, IT/IS systems)?
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Evaluate the power system for load shedding potential?
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Identify equipment or areas in the facility that will be unavailable for use?
3. Does your clinic have procedures to communicate situation and safety information to staff, patients and families?
4. Does your clinic have procedures to evaluate need for and obtain additional staff?
5.
Does your clinic have a process to determine the need for partial or complete evacuation of the facility to protect patients and staff?
Response & Recovery
1.
Does your clinic have procedures for obtaining situation reports and utility status updates from the local emergency management agency and utility?
2. Does clinic have a mechanism for regularly evaluating generator and electrical system performance?
What is the short and long-term impact of the loss the HVAC on the patients, staff and facility?
Does your clinic have a process to determine the need for canceling non-essential clinic services and activities ?
Does your clinic have a process to assess patients for early discharge to decrease patient census?
Does your clinic have a plan to provide staff information on the situation and emergency measures to implement?
Does your clinic have a plan to secure the facility?
Does your clinic have a plan to document actions, decisions and activities and track response expenses and lost revenues?
Does your clinic have procedures for restoring normal facility services, and non-essential service operations?
Does your clinic have procedures for repatriation of patients that were transferred or evacuated?
Does your clinic have procedures for after action reporting and developing an improvement plan?