ࡱ> |}~ bjbj xx= RRRRRt<~!P'4'''0* :-t.̗ΗΗΗΗΗΗ$cNRj/))^j/j/1RR''N111j/vR'R'̗1j/̗11:“ʐS/jҏH0gJ0Bg“1“JR j/j/j/1j/j/j/j/j/j/j/gj/j/j/j/j/j/j/j/j/ * :   Survey & Certification Emergency Preparedness & Response  FORMTEXT Enter Organization Name Health Care Provider After Action Report/Improvement Plan  FORMTEXT Enter Full Name of Exercise or Event Prepared by  FORMTEXT       Prepared for  FORMTEXT       Date(s) of Exercise or Event  FORMTEXT       Publication Date  FORMTEXT       TABLE OF CONTENTS  TOC \o "1-3" \h \z \u   HYPERLINK \l "_Toc225133408" Executive Summary  PAGEREF _Toc225133408 \h 1  HYPERLINK \l "_Toc225133409" Section 1: Exercise Overview  PAGEREF _Toc225133409 \h 2  HYPERLINK \l "_Toc225133410" Section 2: Exercise Design Summary  PAGEREF _Toc225133410 \h 4  HYPERLINK \l "_Toc225133411" Section 3: Improvement Plan  PAGEREF _Toc225133411 \h 6  HYPERLINK \l "_Toc225133412" Section 4: Conclusion  PAGEREF _Toc225133412 \h 7  HYPERLINK \l "_Toc225133417" APPENDIX A: ACRONYMS  PAGEREF _Toc225133417 \h 8  HYPERLINK \l "_Toc225133413" APPENDIX B: LESSONS LEARNED (Optional)  PAGEREF _Toc225133413 \h 8  HYPERLINK \l "_Toc225133414" APPENDIX C: PARTICIPANT FEEDBACK SUMMARY (Optional)  PAGEREF _Toc225133414 \h 10  HYPERLINK \l "_Toc225133415" APPENDIX D: EXERCISE EVENTS SYNOPSIS (Optional)  PAGEREF _Toc225133415 \h 12  HYPERLINK \l "_Toc225133415" APPENDIX E: EXERCISE EVENTS SUMMARY TABLE (Optional)  PAGEREF _Toc225133415 \h 12  Executive Summary The Executive Summary section should be used to briefly describe all of the information contained in the following sections of the After Action Report/Improvement Plan (AAR/IP) to highlight the report and assist partnering agencies in striving for preparedness excellence. The overview should discuss why the exercise was conducted, the exercise objectives, a list of the agencies that participated, and what target capabilities (select capabilities from Target Capabilities List included on pages 3-4 terms from the Health Care Provider AAR/IP Instruction packet), activities and scenarios were used to achieve those objectives. All of these areas will be discussed in more detail in subsequent sections of the AAR/IP. Enter a brief overview of the exercise FORMTEXT       Enter the capabilities tested by the exercise (reference Targeted Capabilities List on pages 3-4 of AAR/IP Instruction packet) FORMTEXT       Enter the major strengths identified during the exercise (include the top 3 strengths, at a minimum) FORMTEXT       Enter areas for improvement identified during the exercise, including recommendations (include the top 3 areas, at a minimum) FORMTEXT       Describe the overall exercise as successful or unsuccessful, and briefly state the areas in which subsequent exercises should focus FORMTEXT        Section 1: Exercise/Event Overview The Exercise Overview section should be used to briefly describe the following: The specific details of the exercise or event The agencies and organizations that participated in the exercise or event How the exercise or event was structured How the exercise or event was implemented and carried out Exercise/Event Name:  FORMTEXT       Exercise/Event Start Date:  FORMTEXT       Exercise/Event End Date:  FORMTEXT       Duration (insert the total length of the exercise or event in terms of days or hours, as appropriate):  FORMTEXT       Type of Exercise/Event Completed: Check the type of exercise completed, as listed below (see key terms included on pages 4-5). Discussion-Based Exercise  FORMCHECKBOX  Seminar  FORMCHECKBOX  Workshop  FORMCHECKBOX  Tabletop  FORMCHECKBOX  Games Operations-Based Exercise  FORMCHECKBOX  Drill  FORMCHECKBOX  Full-Scale Exercise  FORMCHECKBOX  Functional Exercise Emergency Event  FORMCHECKBOX  Event Capabilities: List the appropriate targeted capabilities of the exercise/event (refer to AAR/IP Instruction Packet, pages 3-4, TCL capabilities identified in red, e.g., medical surge, isolation & quarantine, etc.):  FORMTEXT        Scenario: Describe the exercise scenario type (e.g., flood, hurricane, etc.)  FORMTEXT        Location:  FORMTEXT        Partners: List all partners, contractors, supporting/co-sponsoring organizations:  FORMTEXT        Participants: List all individual participating organizations or agencies  FORMTEXT        Number of Participants: List the total number of: Players:  FORMTEXT       Victim role players:  FORMTEXT       Controllers:  FORMTEXT       Evaluators:  FORMTEXT       Facilitators:  FORMTEXT       Observers:  FORMTEXT       Section 2: Exercise Design Summary Exercise Purpose and Design: Briefly summarize why the exercise was conducted and what the participants hoped to learn. Include a brief history of how the exercise was organized, designed, funded, etc.  FORMTEXT        Exercise Objectives and Capabilities: List the exercise objectives followed by the capabilities for each objective. The number of objectives and capabilities will vary based on the scope of the exercise and the number of participating agencies.  FORMTEXT        Scenario Summary: This section should summarize the scenario or situation initially presented to players, subsequent key events introduced, and the time in which these events occurred. For a table-top exercise, this section should outline the scenario used and/or modules presented to the participants.  FORMTEXT        Analysis of Critical Objectives Performance The Analysis of Critical Objectives Performance section reviews performance of the individual objectives and tasks. This section should provide the most detail regarding each behavior or action at the core of the observation. Each objective identified to be performed for the simulated event defined by the scenario should be discussed. Those objectives and tasks that were performed as expected require only a short write up that describes how the task was performed. For objectives and tasks that were not performed as expected, describe what did or did not happen and the root causes for the variance from the plan, established procedures, or agreements. This section should indicate if the variance from expected performance resulted in an improved response, which may result in a recommendation that plans or procedures be changed. Recommendations for improvement should be presented for these tasks. Innovative approaches that were used should be highlighted and described. Please reference the Exercise Evaluation Guide (EEG) for each capability at  HYPERLINK "https://hseep.dhs.gov/pages/1002_EEGLi.aspx" https://hseep.dhs.gov/pages/1002_EEGLi.aspx. Below is the recommended format for presenting each Capability Capability - Identify the capability from the Targeted Capabilities List:  FORMTEXT      Summary of Observation:Objective: Align the capability to specific objective FORMTEXT       Activity:  FORMTEXT List the activity and reference critical tasks from the EEG FORMTEXT       Task: Reference the critical task from the EEG (please see applicable EEG posted at https://hseep.dhs/gov/pages/1002_EEGLi.aspx): FORMTEXT       Analysis FORMTEXT       Recommendation: Insert recommendations to address identified areas for improvement, based on the judgment and experience of the evaluation team. If the observation was identified as strength, without corresponding recommendations, insert  None.  FORMTEXT        SECTION 3: IMPROVEMENT PLAN This Improvement Plan (IP) should include the top three key recommendations and corrective actions (at a minimum) identified in the Critical Objectives Performance section. Insert additional rows to the table if more than three recommendations and corrective actions have been identified. CapabilityTop 3 ObservationsTop 3 RecommendationsCorrective Action DescriptionResponsible FacilityFacility POCStart DateCompletion Date Observation 1 Recommendation 1      Observation 2 Recommendation 2      Observation 3 Recommendation 3       CapabilityTop 3 ObservationsTop 3 RecommendationsCorrective Action DescriptionResponsible FacilityFacility POCStart DateCompletion Date Observation 1 Recommendation 1      Observation 2 Recommendation 2      Observation 3 Recommendation 3       CapabilityTop 3 ObservationsTop 3 RecommendationsCorrective Action DescriptionResponsible FacilityFacility POCStart DateCompletion Date Observation 1 Recommendation 1      Observation 2 Recommendation 2      Observation 3 Recommendation 3       Section 4: Conclusion This section is a conclusion for the entire document, and should be used as a summary of all the sections of the AAR/IP. The Conclusion should include the following: Participants demonstrated capabilities Lessons learned Top 3 recommendations (at a minimum) Summary of what steps should be taken to ensure that the concluding results will help to further refine plans, procedures and training for this type of incident.  FORMTEXT        APPENDIX A: ACRONYMS Any acronym used in the AAR/IP should be listed alphabetically and spelled out. ACRONYMSAcronymMeaning     APPENDIX B: LESSONS LEARNED (Optional) While the After Action Report/Improvement Plan includes recommendations which support development of specific post-exercise corrective actions, exercises may also reveal lessons learned which can be shared with the broader health care and homeland security audience. The Department of Homeland Security (DHS) maintains the Lessons Learned Information Sharing (LLIS.gov) system as a means of sharing post-exercise lessons learned with the emergency response community, including health care providers. All are welcome to use this website, which provides jurisdictions and organizations the opportunity to nominate lessons learned from exercises for sharing on LLIS.gov. For reference, the following are the categories and definitions used in LLIS.gov: Lesson Learned: Knowledge and experience, positive or negative, derived from actual incidents, such as the 9/11 attacks and Hurricane Katrina, as well as those derived from observations and historical study of operations, training, and exercises. Best Practices: Exemplary, peer-validated techniques, procedures, good ideas, or solutions that work and are solidly grounded in actual operations, training, and exercise experience. Good Stories: Exemplary, but non-peer-validated, initiatives (implemented by various jurisdictions) that have shown success in their specific environments and that may provide useful information to other communities and organizations. Practice Note: A brief description of innovative practices, procedures, methods, programs, or tactics that an organization uses to adapt to changing conditions or to overcome an obstacle or challenge. Exercise Lessons Learned: Insert an account of any lessons learned. If the account is being nominated for inclusion in the DHS LLIS.gov system (optional), include a statement to that effect:  FORMTEXT        APPENDIX C: PARTICIPANT FEEDBACK SUMMARY (Optional) Following is a sample Participant Feedback Form, which should be distributed to the exercise participants at a post-exercise session. 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PARTICIPANT FEEDBACK FORMExercise Name:  FORMTEXT      Exercise Date:  FORMTEXT      Participant Name:  FORMTEXT      Agency Name:  FORMTEXT      Role: FORMCHECKBOX  Player  FORMCHECKBOX  Observer  FORMCHECKBOX  Facilitator  FORMCHECKBOX  EvaluatorPart I: Recommendations and Corrective Actions1. Based on the exercise today and the tasks identified, list the top 3 strengths and/or areas that need improvement. FORMTEXT       2. Is there anything you saw in the exercise that the evaluator(s) might not have been able to experience, observe and record? FORMTEXT       3. Identify the corrective actions that should be taken to address the issues identified above. For each corrective action, indicate if it a high, medium or low priority. FORMTEXT       4. Describe the corrective actions that relate to your area of responsibility. Who should be assigned responsibility for each corrective action? FORMTEXT       5. List the applicable equipment, training, policies, plans and procedures that should be reviewed, revised, or developed. Indicate the priority level for each. FORMTEXT        Part II  Exercise Design and Conduct: AssessmentPlease rate on a scale of 1 to 5, your overall assessment of the exercise relative to the statements provided below, with 1 indicating strong disagreement with the statement and 5 indicating strong agreement.PARTICIPANT ASSESSMENTAssessment FactorStrongly Agree Strongly DisagreeThe exercise was well structured and organized.12345The exercise scenario was plausible and realistic.12345The facilitator/controller kept the exercise on target.12345The exercise documentation provided to assist in preparing for and participating in the exercise was useful.12345Participation in the exercise was appropriate for someone in my position.12345The participants included the right people in terms of level and mix of disciplines.12345This exercise allowed my health care facility to practice and improve priority capabilities.12345After this exercise, I believe my health care facility is better prepared to successfully deal with the scenario that was exercised.12345Part III - Participant FeedbackPlease provide any recommendations on how this exercise or future exercises could be improved or enhanced. FORMTEXT        APPENDIX D: EXERCISE EVENTS Synopsis (Optional) The Exercise Events Synopsis section is optional for HSEEP compliance. If completing this section, it should provide a narrative overview of the scenario used to facilitate the exercise actions taken by the players to respond to the simulated event (similar to the Hospital Incident Command System HICS-214 form). If completing present the general timeline of events that happened at each site. The synopsis provides a means of looking at the ramifications of the cause and effect of specific actions on others actions taken by other players and on the overall response. The  Exercise Events Synopsis should include a narrative of the synopsis, the modules for the exercise, and a timeline of events for each element of play.  FORMTEXT        APPENDIX E: EXERCISE EVENTS SUMMARY TABLE (Optional) In formulating its analysis the evaluation team may assemble a timeline of key exercise events. The evaluation team may find value in including a timeline as an appendix to their report. If so, this section should summarize what actually happened during the exercise in a timeline table format. 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Successful development of this section is aided by the design, development and planning actions of the exercise design team. Prior to the exercise, the exercise design team should have developed a timeline of anticipated key events. An example of the format for the Exercise Events Summary Table is presented below: EXERCISE EVENTS SUMMARYDateTimeScenario EventEvent/Action         DEPARTMENT OF HEALTH HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Survey & Certification Emergency Preparedness & Response Health Care Provider After Action Report/Improvement Plan PAGE  Page PAGE 13 Revised September 30, 2009 U.S. DEPARTMENT OF HEALTH HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Health Care Provider After Action Report/Improvement Plan Page PAGE 1 Revised September 30, 2009 U.S. DEPARTMENT OF HEALTH HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Health Care Provider After Action Report/Improvement Plan  U.S. DEPARTMENT OF HEALTH HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Health Care Provider After Action Report/Improvement Plan  U.S. DEPARTMENT OF HEALTH HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Health Care Provider After Action Report/Improvement Plan  ݑޑ~~~~ 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