Mass-Casualty Exercise Design for EMS Agencies

Agencies should avoid overwhelming responders with prematurely complicated exercises. For example, an agency can begin by conducting separate drills on triage, the incident command system and equipment utilized in mass-casualty incidents. Next, it could conduct a tabletop exercise with other agencies to assess respective roles, responsibilities and needs in such an incident. Finally, the jurisdiction could hold a full-scale exercise to test the efficacy of the implemented solutions to issues identified in the drills and tabletop. Utilizing such a strategy helps agencies highlight and correct both major and minor issues early, allowing the more complex exercises to be better opportunities for evaluation, practice and fine-tuning.

The Exercise Planning Process

Whether an exercise involves a single agency or those of an entire community, its educational value and success hinges on appropriate participation and commitment of resources.

Planning an exercise necessarily requires input from representatives of all areas. If an EMS agency tabletop exercise involving a building collapse would include operations, special operations, communications and rescue divisions, then representatives from all these areas should drive the planning. For a community-wide exercise, especially a full-scale training event, representatives could include law enforcement, the fire service, EMS, hazmat, public health, hospitals, local and/or state emergency management, public works, National Guard and representatives of the exercise site.

Perhaps the most important step in exercise planning is the development of design objectives, which state what areas the exercise will attempt to assess. Determined by the planning team, these objectives propel the development of the scenario itself. While a full-scale exercise involving many agencies could have many objectives, it is best to limit the number to a few key objectives for any one exercise. Such objectives could involve triage, the tracking of patients, communications with hospitals, interagency coordination, staging, decontamination or any number of other possibilities. Analysis of past exercises or actual events often highlights areas worthy of further assessment. What an agency or community wishes to test will determine the scenario, including the location, context, number of victims and their injuries, agent used (if it's a hazmat or WMD scenario) and other challenges involved, such as simultaneous emergencies or road closures.

Details of the exercise, minus the particulars of the scenario itself, are set forth in an exercise plan. This plan contains information on the date, time and location of the exercise, participating agencies, logistical and safety issues, schedules, maps, radio frequencies and more. Information for the exercise staff, including the scenario elements, evaluation forms and activity log sheets, are often presented in another manual, which may be called a controller and evaluator handbook, control staff instructions or evaluation plan.

Control and Evaluation

Due to their intimate knowledge of the scenario, members of the planning group often form the core of the exercise staff. Aside from those responsible for logistical concerns, the exercise staff usually addresses two distinct but interdependent functions: control and evaluation.

In order for an exercise to fulfill its objectives, it must be delivered appropriately and proceed as planned. Managing the exercise scenario is the responsibility of controllers. While controllers should generally allow responders to address the scenario without interference, often input is needed to inject scenario elements, keep responder actions from undermining the value of the exercise and address safety hazards. Evaluators, on the other hand, attempt to be "invisible," capture observations about the response and maintain timelines of exercise activities. This documentation is invaluable for analysis in the after-action report.

It often works well to pair a member of a local agency with a subject-matter expert from another jurisdiction for the controller-evaluator team in each functional area. Such a pairing allows for both objective analysis and intimate knowledge of local standard operating procedures. Controllers in a tabletop exercise are often called facilitators, as they generally are responsible for leading discussion following scenario presentations by slide show or the equivalent. For any exercise, controllers and evaluators should participate in a briefing to orient them to their roles prior to the event itself.