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Evaluation of Hospital Disaster Drills: A Module-Based Approach

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Biological Incident Addendum

These evaluation forms are designed to help hospitals compile responses from the modules and compare data.

Pre-Drill Module / Main Module / Biological Incident Addendum / Radiological Incident Addendum

Hospital # Question Incident Command Center Decontamination Triage Treatment
Section
Observer Information   Date        
Observer name        
Observer title        
Time period of evaluation        
Time Points BA1 Time zone aware that victims affected by biological illness        
  Comments:        
Information Flow BA2 Was Incident Commander informed that biological illness present? Y / N / U        
BA3 Method to notify incident commander a. FAX sent        
b. E-mail sent        
c. Person-to-person contact        
d. Telephone message        
e. Unclear        
f. NA        
g. Other (specify)        
BA4 Time after biological illness suspected that incident commander notified <30 min        
30-59 min        
1-2 hrs        
>2 hrs        
Unclear        
NA        
BA5 Hospital epidemiologist or designee informed that biological illness present Y / N / U        
BA6 Method to notify epidemiologist or designee a. FAX sent        
b. E-mail sent        
c. Person-to-person contact        
d. Telephone message        
e. Unclear        
f. NA        
g. Other (specify)        
BA7 Time after biological illness suspected that epidemiologist or designee notified <30 min        
30-59 min        
1-2 hrs        
>2 hrs        
Unclear        
NA        
BA8 Local and/or State health department informed that biological illness present Y / N / U        
BA9 Method to notify local and/or State health department a. FAX sent        
b. E-mail sent        
c. Person-to-person contact        
d. Telephone message        
e. Unclear        
f. NA        
g. Other (specify)        
BA10 Time after biological illness suspected that local and/or State health department notified <30 min        
30-59 min        
1-2 hrs        
>2 hrs        
Unclear        
NA        
BA11 CDC informed that biological illness present? Y / N / U        
BA12 Method to notify Centers for Disease Control and Prevention (CDC) a. FAX sent        
b. E-mail sent        
c. Person-to-person contact        
d. Telephone message        
e. Unclear        
f. NA        
g. Other (specify)        
BA13 Time after biological illness suspected that CDC notified <30 min        
30-59 min        
1-2 hrs        
>2 hrs        
Unclear        
NA        
BA14 Occupational health informed that biological illness present? Y / N / U        
BA15 Method to notify occupational health a. FAX sent        
b. E-mail sent        
c. Person-to-person contact        
d. Telephone message        
e. Unclear        
f. NA        
g. Other (specify)        
BA16 Time after biological illness suspected that occupational health notified <30 min        
30-59 min        
1-2 hrs        
>2 hrs        
Unclear        
NA        
  Comments:        
Materials and Supplies BA17 Needed vaccines available within hospital? Y / N / U / NA        
BA18 Vaccines requested from outside source? Y / N / U / NA        
BA19 Did vaccines arrive? Y / N / U / NA        
BA20 Approximate time between request and delivery of vaccines from outside agency <2 hrs        
2-6 hrs        
7-12 hrs        
13-24 hrs        
>24 hrs        
Did not arrive        
NA        
  Comments:        
Victim Diagnosis BA21 Cause of suspected biological illness known prior to arrival of affected victims in this zone? Y / N / U        
BA22 How long after arrival of first victim was cause known <1 hr        
1-4 hrs        
5-8 hrs        
>8 hrs        
Never identified        
NA        
BA23 Cause of illness a. Anthrax        
b. Botulism        
c. Plague        
d. Severe Acute Respiratory Syndrome (SARS)        
e. Smallpox        
f. Tularemia        
g. Viral hemorrhagic fever        
h. Unknown        
i. Other (specify)        
BA24 Resources used to make diagnosis a. Consultation with in-hospital expert        
b. Consultation with expert from another hospital        
c. Consultation with expert from local health department        
d. Consultation with expert from State health department        
e. Consultation with CDC        
f. History and physical exam by treating physician        
g. Microbiological data        
h. Radiologic data        
i. NA        
j. Other (specify)        
BA25 Cameras used to document cases? Y / N / U / NA        
  Comments:        
Safety: Isolation Precautions BA26 Isolation required for suspected biological illness involved? Y / N / U        
BA27 Victims transported to isolation room? Y / N / U / NA        
BA28 Receiving room under negative pressure? Y / N / U / NA        
BA29 Enough isolation rooms? Y / N / U        
BA30 How victims isolated a. Conversion of other rooms/area (specify)        
b. Existing isolation room in other area (specify)        
c. Overflow victims not isolated        
d. Victims with same suspected biologic illness placed in same isolation room        
e. NA        
f. Other (specify)        
BA31 Signs on victims' doors describing type of isolation required? Y / N / U        
BA32 Sign-in sheet placed at each isolation room door? Y / N / U        
BA33 Health care workers sign in and out? Y / N / U / NA        
BA34 Breaches in isolation precautions identified? (explain in comment box) Y / N / U        
BA35 Victims with similar symptoms grouped together in the zone? Y / N / U / NA        
BA36 Unaffected patients removed from areas with affected victims? Y / N / U / NA        
BA37 Precautions taken when handling materials or equipment that came in contact with potentially infected victims? Y / N / U        
BA38 Masks supplied to unaffected victims in zone? Y / N / U / NA        
BA39 Lists of exposed and non-exposed victims generated? Y / N / U        
BA40 Representatives from infection control arrive to assess appropriateness of isolation precautions? Y / N / U        
  Comments:        
Safety: Personal Protective Equipment BA41 PPE needed to protect health care workers? Y / N / U        
  Safety measures available        
BA42 Passive (negative pressure) filtration Available        
Used by staff        
Adequate supply        
BA43 Powered (positive pressure) filtration Available        
Used by staff        
Adequate supply        
BA44 Self-contained breathing apparatus Available        
Used by staff        
Adequate supply        
BA45 Level B or higher suits Available        
Used by staff        
Adequate supply        
BA46 Other (specify) Available        
Used by staff        
Adequate supply        
BA47 Other (specify) Available        
Used by staff        
Adequate supply        
BA48 Other (specify) Available        
Used by staff        
Adequate supply        
BA49 Any observed staff without PPE interacting with contaminated victims? Y / N / U / NA        
BA50 Types of staff w/o PPE interacting with contaminated victims a. Ancillary staff        
b. Nurses        
c. Physicians        
d. Did not observe        
NA        
Other (specify)        
  Comments:        
Screening and Prophylaxis BA51 Prophylactic medications available for health care workers exposed to plague or anthrax? Y / N / U / NA        
BA52 Prophylactic medications available for victims exposed to plague or anthrax? Y / N / U / NA        
BA53 Vaccinations available for health care workers exposed to smallpox? Y / N / U / NA        
BA54 Vaccinations available for victims exposed to smallpox? Y / N / U / NA        
BA55 Method to manage victims needing screening for exposure and / or prophylaxis a. Emergency department        
b. Referred to health department clinic        
c. Referred to hospital clinic        
d. Triage        
e. Other (specific)        
  Comments:        
Laboratory Specimens BA56 Means to transport specimens to lab a. Hand carried        
b. Packaged for sending to outside labs        
c. Other (specify)        
BA57 Guidelines available for packaging and transport of microbiological specimens? Y / N / U        
BA58 "Chain of custody" implemented? Y / N / U        
  Comments:          

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