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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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Incident Command Center Zone Module


This module was developed by the Johns Hopkins Evidence-based Practice Center under Contract No. 290-02-0018 from the Agency for Healthcare Research and Quality, Rockville, MD. The content of this module is intended to provide guidance for hospital disaster drill evaluation and should not be construed as representing standards of care or recommendations on how to respond to specific types of disasters. No statement in this module should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.


Note: Circle or check (_) as indicated. Y = Yes; N = No; U = Unclear; NA = Not applicable


Observer: ______________________________________________________________             Date: ____/____/____

Observer title: ___________________________________________________________

Hospital: _______________________________________________________________

Period of time of evaluation: _____________ AM / PM (Circle one) to _____________ AM / PM (Circle one)

Time Points

Event Time
C1. Time the drill began: (Circle one) _____________ AM / PM / U
C2. Time the hospital disaster plan was initiated in this zone: (Circle one) _____________ AM / PM / U / Not initiated
C5. Time the drill ended in this zone: (Circle one) _____________ AM / PM / U

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Zone Description:

C6. Draw a picture of the zone setup.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Question Response

C7. Where was this zone located? (Check all that apply)

a. [  ] Ambulance ramp
b. [  ] Inside the hospital
c. [  ] Parking lot
d. [  ] Street/road
e. [  ] Other (specify):
________________________________

C8. Was the boundary for this zone defined?

Y / N / U
C9. If this zone had a defined boundary, how was it defined? (Check all that apply) a. [  ] Barricade(s)
b. [  ] Security personnel
c. [  ] Sign(s)
d. [  ] Tape
e. [  ] Vehicle(s)
f.  [  ] Wall(s), permanent
g. [  ] Wall(s), temporary
h. [  ] No boundary
i.  [  ] Other (specify):
________________________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Personnel

Question Response

C11. Did someone take charge of this zone?

Y / N / U
C12. If someone took charge of this zone, how many minutes after the drill activities in this zone began did this person take charge? (Check one) O < 10 min
O 10-29 min
O 30-59 min
O 1-2 hrs
O > 2 hrs
O NA

C13. If someone took charge of this zone, was it the officially designated person?

Y / N / U / NA

C14. How was the person in charge of the zone identified? (Check all that apply)

a. [  ] Arm band
b. [  ] Hat
c. [  ] Name tag
d. [  ] Verbal statement
e. [  ] Vest
f.  [  ] Not identified
g. [  ] Other physical identification (specify): ______________________________________

C15. Were the following drill participants identifiable?

a. Drill evaluators Y / N / U / NA
b. Drill organizers Y / N / U / NA
c. Media Y / N / U / NA
d. Medical personnel Y / N / U / NA
e. Mock victims Y / N / U / NA
f. Observers Y / N / U / NA
g. Security Y / N / U / NA

Question Response

IC1. Who first took charge of this zone? (name and title)


______________________________________

______________________________________
IC2. How many minutes after the drill activities in this zone began did the officially designated incident commander arrive? (Check one) O < 10 min
O 10-29 min
O 30-59 min
O 1-2 hrs
O > 2 hrs
O Never arrived

IC3. Were other members of the incident command center easily identifiable?

Y / N / U

Was someone fulfilling the functions of the following roles (within the incident command center or elsewhere) or reporting to the incident command center?

If no one fulfilled a specified function, circle "N" in column "a" and go to the next row.

Role a. Function filled b. Comments
IC4. Incident Commander Y / N / U / NA  
IC5. Public Information Officer (contacts with media and community) Y / N / U / NA  
IC6. Liaison Officer (contacts with outside hospitals or agencies) Y / N / U / NA  
IC7. Safety and Security Officer Y / N / U / NA  
IC8. Logistics Chief (oversees the next 5 areas below) Y / N / U / NA  
IC9. Facilities Management Unit Leader (physical plant issues) Y / N / U / NA  
IC10. Communications Unit Leader (internal communications, e.g., paging) Y / N / U / NA  
IC11. Patient Transportation Unit Leader Y / N / U / NA  
IC12. Material/Supply Unit Leader Y / N / U / NA  
IC13. Nutritional Supply Unit Leader Y / N / U / NA  
IC14. Planning Chief (oversees the next 3 areas below) Y / N / U / NA  
IC15. Labor Pool Unit Leader (Ancillary staff) Y / N / U / NA  
IC16. Medical Staff Unit Leader Y / N / U / NA  
IC17. Nursing Unit Leader Y / N / U / NA  
IC18. Finance Chief Y / N / U / NA  
IC19. Operations Chief oversees the next 3 areas below Y / N / U / NA  
IC20. Medical Care Director (patient care areas and issues) Y / N / U / NA  
IC21. Ancillary Services Director (laboratory, radiology, pharmacy, etc.) Y / N / U / NA  
IC22. Human Services Director (staff and psychological support) Y / N / U / NA  
IC23. Other (specify):
_________________________________
Y / N / U / NA  
IC24. Other (specify):
_________________________________
Y / N / U / NA  
IC25. Other (specify):
_________________________________
Y / N / U / NA  

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Zone Operations

Question Response

C23. When was the location of this zone determined? (Check one)

O Determined before the drill
O Determined during the drill

C24. Was the hospital disaster plan available?

Y / N / U

C25. If the hospital disaster plan was available, what was its format? (Check all that apply)

a. [  ] Complete manual
b. [  ] Flow diagram
c. [  ] Job action sheets
d. [  ] No disaster plan
e. [  ] Other (specify):
________________________________

C26. If the hospital disaster plan was available, how was it accessed? (Check all that apply)

a. [  ] Computer/Internet
b. [  ] Paper
c. [  ] Personal data assistant (PDA)
d. [  ] Not accessed
e. [  ] Other (specify):
________________________________

C27. Was there a biological incident component to the hospital disaster plan?

Y / N / U

C28. Was there a radiation incident component to the hospital disaster plan? Y / N / U

C29. Was the space allocated for the zone adequate?

Y / N / U

C30. If not enough space for the zone, where did zone activities overflow to? (Check all that apply)

a. [  ] Adequate space allotted
b. [  ] Conference room
c. [  ] Hallways
d. [  ] Outside hospital
e. [  ] Treatment/victim care areas
f.  [  ] Waiting rooms
g. [  ] No overflow
h. [  ] NA
i.  [  ] Other (specify):
________________________________

C31. Was this zone used for the same functions during non-drill operations?

Y / N / U

C32. If this zone was not used for the same functions in non-drill operations, what was it usually used for? (Check all that apply)

a. [  ] Ambulance ramp
b. [  ] Conference room
c. [  ] Hallway
d. [  ] Lobby
e. [  ] Treatment, emergency
f.  [  ] Treatment, non-emergency
g. [  ] Triage
h. [  ] Unused
i.  [  ] Waiting room
j.  [  ] Other (specify):
________________________________

IC26. How was the incident command center configured? (Check one)

O One room
O Two or more contiguous rooms
O Two or more non-contiguous rooms
O Other (specify):
____________________________________

IC27. Approximate number of people in the incident command center. (Check one)

O < 5
O 6 - 10
O 11 - 20
O > 20

IC28. Did the noise level in the incident command center interfere with effective communication?

Y / N / U

IC29. If the noise level interfered with communications, were steps taken to correct the problem? Y / N / U / NA

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Communications

If device not present, circle "N" in column "a" and go to the next line.

Communication Device(s) a. Was device present? b. If present, # available c. If present, was it used in drill? d. Comments (note problems)
Phone
C36. 2-way radio/phone(s) Y / N / U   Y / N / U  
C37. Direct line(s) Y / N / U   Y / N / U  
C38. Landline phone(s) Y / N / U   Y / N / U  
C39. Wireless/cell phone(s) Y / N / U   Y / N / U  
Radio and Television
C40. AM/FM radio(s) Y / N / U   Y / N / U  
C41. Television(s) Y / N / U   Y / N / U  
Pager
C42. Numeric paging Y / N / U   Y / N / U  
C43. Overhead paging Y / N / U   Y / N / U  
C44. Text paging Y / N / U   Y / N / U  
Other Electronic Device
C45. E-mail & Internet access Y / N / U   Y / N / U  
C46. FAX machine(s) Y / N / U   Y / N / U  
Voice or Physical Communication Device
C47. Intercom Y / N / U   Y / N / U  
C48. Megaphone(s) Y / N / U   Y / N / U  
C49. Runner(s) Y / N / U   Y / N / U  
Other (Specify)
C50. ______________________ Y / N / U   Y / N / U  
C51. ______________________ Y / N / U   Y / N / U  
C52. ______________________ Y / N / U   Y / N / U  

Question Response
C53. How was incoming information to the zone recorded? (Check all that apply) a. [  ] Computer (other electronic device)
b. [  ] Notepaper
c. [  ] Posted paper
d. [  ] White board/chalk board
e. [  ] Not recorded
f.  [  ] Other (specify):
________________________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Information Flow

Question Response

C54. How was this zone notified of the event? (Check all that apply)

a. [  ] FAX
b. [  ] Runner
c. [  ] Telephone
d. [  ] Not notified
e. [  ] Other (specify):
________________________________

C55. Who notified this zone of the event? (Check all that apply)

a. [  ] Drill organizer
b. [  ] Incident command center
c. [  ] Media
d. [  ] Other hospital staff
e. [  ] Outside source
f.  [  ] Victims arriving
g. [  ] Not notified
h. [  ] Other (specify):
________________________________

C59. Were problems created by delays in receiving information?

(If problems were created by delays in information, specify in comment box at end of this section.)

Y / N / U

How often was the following information received by the incident command center?

If this information was not received, circle "NA" and go to the next row.

Information Circle approximately how often
IC30. Available operating rooms once / multiple updates / U / NA
IC31. Available staffed floor beds once / multiple updates / U / NA
IC32. Available staffed intensive care beds once / multiple updates / U / NA
IC33. Available staffed isolation beds once / multiple updates / U / NA
IC34. Number of arriving victims once / multiple updates / U / NA
IC35. Estimated time window of victims' arrival once / multiple updates / U / NA
IC36. Expected triage level of victims once / multiple updates / U / NA
IC37. Number of victims Emergency Department can accept once / multiple updates / U / NA
IC38. Clinical staff available (e.g., physicians, nurses) once / multiple updates / U / NA
IC39. Total number of expected victims once / multiple updates / U / NA
IC40. Potential discharges of 'actual' patients once / multiple updates / U / NA
IC41. Support staff available (e.g., registrar, security) once / multiple updates / U / NA
IC42. Other (specify):
________________________________
once / multiple updates / U / NA
IC43. Other (specify):
________________________________
once / multiple updates / U / NA
IC44. Other (specify):
________________________________
once / multiple updates / U / NA

Question Response

IC45. What means did the incident command center use to receive data from within the hospital? (Check all that apply)

a. [  ] 2-way radio/phone
b. [  ] Cell phone
c. [  ] Computer
d. [  ] FAX
e. [  ] Landline phone
f.  [  ] Pager
g. [  ] Runners
h. [  ] No data received
i.  [  ] Other (specify):
________________________________

IC46. Did the hospital activate a memorandum of understanding (MOU) with any external agency regarding use of services or resources?

(If MOU was activated, specify in comment box at end of this section.)

Y / N / U / NA

Was the incident command center in communication with outside agencies? (Check all that apply)

If not in communication with outside agencies, circle "N" in column "a" and go to the next row.

Outside Agencies a. Contacted b. Note any issues with communication
IC47. Ambulance systems Y / N / U / NA  
IC48. Disaster response agency (State or Federal) (e.g., FEMA) Y / N / U / NA  
IC49. Fire Y / N / U / NA  
IC50. Health department (local, State, or Federal) Y / N / U / NA  
IC51. Media Y / N / U / NA  
IC52. Military Y / N / U / NA  
IC53. Other hospitals Y / N / U / NA  
IC54. Police Y / N / U / NA  
IC55. Other (specify):
_____________________________________
Y / N / U / NA  
IC56. Other (specify):
_____________________________________
Y / N / U / NA  

Question Response

IC57. What means did the incident command center use to receive data from outside of the hospital? (Check all that apply)

a. [  ] 2-way radio/phone
b. [  ] Cell phone
c. [  ] Computer
d. [  ] FAX
e. [  ] Landline phone
f.  [  ] Pager
g. [  ] Runners
h. [  ] No data received
i.  [  ] Other (specify):
________________________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Security

Question Response

C60. Were security personnel present in this zone?

Y / N / U

C61. If security were needed but not present, how were they contacted? (Check all that apply) a. [  ] 2-way radio/phone
b. [  ] Overhead pager
c. [  ] No security present
d. [  ] Other (specify):
________________________________

C62. If security personnel were present, what type of security? (Check all that apply and provide approximate numbers)

a. [  ] FBI: ________________
b. [  ] Hospital security: ___________
c. [  ] Local police: __________
d. [  ] State police: _______________
e. [  ] NA
f.  [  ] Other (specify):
________________________________

C63. Did all security staff present have a portable means of communication?

Y / N / U / NA

C64. Were entrances and exits strictly controlled in this area? Y / N / U / NA

Did any of the following security issues arise in this zone?

If the security issue did not arise, circle "N" in column "a" and go to the next row.

Security Issue a. Arose? b. If yes, did security respond? c. If yes, was order maintained? d. Description of issue and measures taken
C65. Access in and out Y / N / U Y / N / U Y / N / U  
C66. Assistance for family members Y / N / U Y / N / U Y / N / U  
C67. Assistance lifting supplies or victims Y / N / U Y / N / U Y / N / U  
C68. Crowd control Y / N / U Y / N / U Y / N / U  
C69. Media control Y / N / U Y / N / U Y / N / U  
C70. Transportation/ traffic control Y / N / U Y / N / U Y / N / U  
C71. Unruly victims Y / N / U Y / N / U Y / N / U  
C72. Other (specify):
________________________________
Y / N / U Y / N / U Y / N / U  
C73. Other (specify):
________________________________
Y / N / U Y / N / U Y / N / U  

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Victim Documentation and Tracking

There are no items for this section in the incident command center zone module.

Victim Flow

There are no items for this section in the incident command center zone module.

Personal Protective Equipment (PPE) and Safety

There are no items for this section in the incident command center zone module.

Equipment and Supplies

There are no items for this section in the incident command center zone module.

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Rotation of Staff

Question Response

C98. Was there a staff rotation/shift change?

Y / N / U

C99. If there was a staff rotation, did the officially designated person in charge of the zone change? Y / N / U / NA

C100. If there was a staff rotation, did problems arise?

(If problems arose, explain in comments box at the end of this section.)

Y / N / U / NA

C101. What method of shift changing was used? (Check one)

O Group shift change
O Staggered shift change
O NA
O Other (specify):
________________________________

C102. How were incoming staff updated? (Check all that apply)

a. [  ] Group briefing
b. [  ] Individual briefing
c. [  ] Written notes
d. [  ] Not updated
e. [  ] NA
f.  [  ] Other (specify):
________________________________

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

 

 

 

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Zone Disruption

Question Response

C103. Was there a plan in place to relocate this zone if necessary?

Y / N / U

C104. Did this zone close at any time during the drill?

If no, disregard the remainder of this section. STOP. This zone module is complete.

Y / N / U

C105. If the zone closed during the drill, what was the reason for closing? (Check all that apply)

a. [  ] Contamination
b. [  ] Other safety concerns
c. [  ] Space
d. [  ] Other (specify):
________________________________

C107. If the zone closed during the drill, were other zones notified?

Y / N / U

C108. If the zone closed during the drill, did it reopen in the same location? Y / N / U

If the zone did reopen in the same location:

   C109. Were operations interrupted until this zone reopened? Y / N / U / NA

   C111. Were other zones notified when this zone reopened?

Y / N / U / NA

   C112. Were any critical issues observed with reopening this zone?

   (If critical issues were observed, explain in the comments box at the end of this section.)

Y / N / U / NA
   C113. If the zone did NOT reopen in the same location, was an alternate site opened? Y / N / U / NA

If the zone reopened in an alternate site:

   C114. Where did the zone reopen? (specify): ____________________________________________________________
   C115. Did the initial zone close before the new zone opened?

Y / N / U / NA

   C116. Were operations interrupted until this zone reopened? Y / N / U / NA
   C117. Was the incident command center notified of this zone's relocation?

Y / N / U / NA

   C118. Were other zones notified of this zone's relocation? Y / N / U / NA
   C119. Were portable means of communication used while relocating this zone?

Y / N / U / NA

   C120. Were any critical issues observed with this relocation?

   (If critical issues were observed, explain in the comments box at the end of this section.)

Y / N / U / NA

Comments (if comment refers to a specific item, give the item number):

 

 

 

 

 

 

 

 

 

 

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