Chapter 3: Use of the Abridged Modules

Overview

The abridged hospital drill evaluation is designed in a set of modules and addendums in a similar fashion to the original drill evaluation tool. This approach was reviewed in detail, and judged to be the most effective presentation as it allows observers in different zones of the drill to work independently and effectively. Each module and specifics for its use is described below. The Decontamination Zone Module is needed for radiation and chemical drills, but currently is not recommended for use in a biological drill because decontamination is generally not necessary in biologic events. Table 1 indicates the use of the different modules for a number of common disaster drill scenarios. If the drill is targeted at a particular clinical area, (e.g., decontamination), other modules can be omitted. For example, omit the Triage Zone Module when there is no victim influx.

Personal protective equipment (PPE) is needed in different areas at different times. The list of PPE for the modules and addendums includes different items on the different forms, reflecting current recommendations. These lists may need to be updated as new knowledge emerges regarding the most appropriate PPE for different types of exposures.

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Description of Modules and Addendums

Pre-drill

The evaluation starts at the planning stage of the drill. This is essential in maximizing the learning opportunities. The Pre-drill Module should be completed by the hospital during the planning stages of the drill, preferably by the planning team as a group. This module should be used in all disaster drills. This form is designed to collect the following:

• Goals and objectives for the scope of the evaluation.
• Sufficient background information to facilitate the drill planning.
• Information on specific areas that the hospital wishes to evaluate.
• Resources required.

Incident Command Center

This abridged module is designed to ascertain information about the basic operation of the incident command system that can be reliably recorded by an observer. This zone module should be used in all disaster drills whenever the drill objective includes evaluation of the incident command structure. This form is designed to assess the following:

• Adequacy of the command structure in the zone.
• Adequacy of staffing in the Incident Command Center.
• Adequacy of communication and information flow within and in and out of the Incident Command Center.
• Adequacy of the security.

Decontamination Zone

This abridged module is designed to collect information about the functioning of the decontamination area. This zone module should be used in all disaster drills in which radiation or chemical exposure is in the scenario and decontamination must be conducted. This form is designed to assess the following:

• Adequacy of the command structure in the zone.
• Adequacy of communication and information flow in the zone.
• Adequacy of victim flow in the zone.
• Adequacy of security and victim and staff safety in the zone.
• Adequacy of staffing in the zone.
• Adequacy of availability and use of decontamination equipment and PPE.

Triage Zone

This abridged module is designed to collect information about the functioning of the triage area(s) in a disaster drill. It can be used in primary or secondary triage areas. This zone module should be used in all disaster drills involving live mock or paper victims. This form is designed to assess the following:

• Adequacy of the command structure in the zone.
• Adequacy of communication and information flow in the zone.
• Adequacy of victim flow in the zone.
• Adequacy of security and victim and staff safety in the zone.
• Adequacy of staffing and physical space in the zone.
• Efficiency and appropriateness of triage activities.

Treatment Zone

This abridged module is designed to collect information about the functioning of the treatment area(s) in a disaster drill. This module should be used whenever the drill objectives include evaluation of patient care activities beyond the triage area. The items are appropriate for use in emergency department-based treatment areas or in other clinical care areas (for example, the radiology department or medical or surgical inpatient floors). This form is designed to assess the following:

• Adequacy of the command structure in the zone.
• Adequacy of communication and information flow in the zone.
• Adequacy of victim flow in the zone.
• Adequacy of security and victim and staff safety in the zone.
• Adequacy of staffing and physical space in the zone.
• Adequacy of treatment operations.
• Adequacy of materials and supplies in the zone.

Group Debriefing Module

This module contains a series of open-ended questions that are designed to elicit valuable information and facilitate discussion during a group debriefing session after completion of a drill.

This module is designed to cover all issues raised during the drill, including incident command structure, communications, security, decontamination, triage, treatment, and other areas. The main objective of the debriefing is to identify issues experienced during the drill that may not be captured by the evaluation modules.

Addendums: Radiological Incident and Biological Incident.

Two addendums are part of the hospital disaster drill evaluation. Addendums must always be used with zone forms. In the case of radiation drills, the Radiological Incident Addendum is added to each of the zone modules. As an example, for a hospital-wide radiation exposure drill, the Radiological Incident Addendum must be added to the Incident Command Center, Decontamination, Triage, and Treatment Zone Modules. In the case of a biological scenario drill, the Biological Incident Addendum should be added to the Incident Command Center, Triage, and Treatment Zone Modules. As shown in Table 1, the Biological Incident Addendum should only be used for drills involving a biological scenario, and the Radiological Incident Addendum should only be used for drills involving a radiation scenario.

The Biological Incident Addendum is designed to collect additional information during drills that address the response to a biological incident. This addendum should be used in all disaster drills that address a biological incident. Due to the complexity of assessing the level of exposure for different biological incidents, an expert in the field should be involved when planning and assessing the drill. This form is designed to assess the following:

• Awareness that a biological agent was the cause of illness.
• Whether appropriate expert monitoring personnel were contacted.
• Whether health and safety needs of staff and victims were met.
• Availability of special medications and supplies.

The Radiological Incident Addendum is designed to gather additional information in drills that address the response to a radiation-related incident. This addendum should be used in all disaster drills that address radiation exposure. Due to the complexity of assessing the level of exposure for different radiation incidents, an expert in the field should be involved when planning and assessing the drill. This form is designed to assess the following:

• Awareness that radiation exposure was the cause of illness.
• Whether appropriate expert monitoring personnel were contacted.
• Whether health and safety needs of staff and victims were met.
• Availability of special supplies.

Observer Training

Training sessions for observers should occur before the drill takes place. Observers need specific zone assignments. Observers will be documenting complex tasks, and need familiarity with the content of the evaluation modules and addendums, as well as the zone configuration and equipment, in order to document correctly. This need not be time consuming; however, it is essential for first time observers/evaluators. The following points need to be made:

• All observations made during the drill are confidential.
• All observers should be familiar with the content of the forms, and the points to describe in the comment sections.
• Observers should be positioned so they are able to see drill activities, but do not obstruct flow.
• Observers may ask questions of drill participants to clarify the actions they have taken or to clarify observations and discussions when necessary in an unobtrusive manner; however, they must refrain from asking leading questions that may alter the actions of participants.
• Observers must not participate in drill activities. If asked a question by a drill participant about a drill issue, they should state that they are evaluating and are unable to answer the question.
• Each question on each module should have a response. The response NA should be indicated only when the question does not apply.

Role of the Evaluation Coordinator

Responsibilities of the Evaluation Coordinator at the hospital include the following:

• Recruiting and selecting observers.
• Training and zone assignment for observers.
• Interacting with the coordinators of a regional drill when the drill involves more than one hospital.
• Assuring that all participants know the code word needed to stop the drill in case of a real emergency.
• Acting as a point of contact for observers during the drill.
• Collecting information from the post-drill debriefing session.
• Monitoring performance of the observers in the various zones during the drill and rotating in new observers as appropriate.
• Collecting forms at the end of the drill and reviewing the forms briefly with the observers to assure completeness and legibility.

Note that additional specific details regarding planning and operationalizing the evaluation of hospital disaster drills can be found in Evaluation of Hospital Disaster Drills: A Module-Based Approach.¹

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Overall Value of the Abridged Modules

The abridged modules are based upon the original complete set of modules; however, critical points have been abstracted to simplify the process of hospital disaster evaluation. Thirty-five percent of the questions in the original modules were retained, although there is variation in the number of retained questions among the modules (33% of the Pre-drill Module questions, 22% of the Incident Command Module questions, 25% of the Decontamination Module questions, 40% of the Triage Module questions, 43% of the Treatment Module questions, 36% of the Biological Incident Addendum questions, and 64% of the Radiological Incident Addendum questions). In addition, all zone modules contain summary questions for each area of evaluation that provide an overall assessment of drill activities in that area. These abridged modules can be used both for real-time evaluation in actual disaster drills as well as for formative evaluation from drill to drill. In addition, they allow for capture of the most critical data that should be collected during the evaluation of any hospital-based drill.

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