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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.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

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Main Spreadsheet

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        
  10 triage        
  20 triage        
  NA        
Time Points C1 Drill began        
C2 Disaster plan initiated in zone        
C3 Time this zone was ready to accept victims        
C4 Time zone notified that ICC operational        
C5 Drill ended in zone        
DE1 Time 1st victim arrived at decon zone        
TG1 Time 1st victim arrived at triage zone        
TX1 Time 1st victim arrived in treatment zone        
  Comments:        
Zone Description C6 Picture of zone setup        
C7 Zone location a. Ambulance ramp        
b. Inside the hospital        
c. Parking lot        
d. Street/road        
e. Other (specify)        
C8 Boundary for zone defined? Y / N / U        
C9 How defined 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)        
C10 Were providers able to move easily through this zone? Y / N / U        
DE2 Type area used for decon a. Covered designated outdoor decon area        
b. Open outdoor decon area        
c. Designated indoor decon area; specify # rooms        
d. Other (specify)        
DE3 Distance EMS offload to decon area (ft)        
TG2 Triage zone contiguous to or located in emergency department (ED) Y / N / U        
TG3 Distance away if not contiguous (ft)        
TX2 Type of unit during day to day activities a. ED        
b. Intensive care        
c. Medical inpatient        
d. Medical outpatient        
e. Surgical inpatient        
f. Surgical outpatient        
g. Other (specify)        
TX3 Location of unit (e.g. floor)        
TX4 Actual patients treated in drill treatment area Y / N / U        
  Comments:        
Personnel C11 Someone in charge of zone? Y / N / U        
C12 Minutes after drill activity began in zone that person took charge <10 min        
10-29 min        
30-59 min        
1-2 hrs        
>2 hrs        
No one        
C13 Officially designated person? Y / N / U / NA        
C14 How person in charge of zone identified a. Arm band        
b. Hat        
c. Name tag        
d. Verbal statement        
e. Vest        
f. Not identified        
g. Other physical identification (specify)        
C15 Drill participants identifiable Drill evaluators        
b. Drill organizers        
c. Media        
d. Medical personnel        
e. Mock victims        
f. Observers        
g. Security        
  Number of hospital participants initially assigned to this zone?        
C16 Physicians #        
C17 Nurses #        
C18 Ancillary personnel #        
C19 Additional drill participants added? Y / N / U        
  Approximate number of additional staff        
C20 Physicians #        
C21 Nurses #        
C22 Ancillary personnel #        
IC1 First took charge of zone? (name and title)        
IC2 Minutes after drill start that designated incident commander arrived <10 min        
10-20 min        
30-59 min        
1-2 hrs        
>2 hrs        
Never arrived        
IC3 Members of incident command identifiable? (Y / N / U)        
  Someone filling functions of following roles or reporting to ICC?        
IC4 Incident Commander Y / N / U / NA Comments        
IC5 Public Information Officer Y / N / U / NA Comments        
IC6 Liaison Officer Y / N / U / NA Comments        
IC7 Safety and Security Officer Y / N / U / NA Comments        
IC8 Logistics Chief Y / N / U / NA Comments        
IC9 Facilities Management Unit Y / N / U / NA Comments        
IC10 Communications Unit Y / N / U / NA Comments        
IC11 Patient Transport Unit Leader Y / N / U / NA Comments        
IC12 Material/Supply Unit Leader Y / N / U / NA Comments        
IC13 Nutritional Supply Unit Leader Y / N / U / NA Comments        
IC14 Planning Chief Y / N / U / NA Comments        
IC15 Labor Pool Unit Leader Y / N / U / NA Comments        
IC16 Medical Staff Unit Leader Y / N / U / NA Comments        
IC17 Nursing Unit Leader Y / N / U / NA Comments        
IC18 Finance Chief Y / N / U / NA Comments        
IC19 Operations Chief Y / N / U / NA Comments        
IC20 Medical Care Director Y / N / U / NA Comments        
IC21 Ancillary Services Y / N / U / NA Comments        
IC22 Human Services Director Y / N / U / NA Comments        
IC23 Other (specify) Y / N / U / NA Comments        
IC24 Other (specify) Y / N / U / NA Comments        
IC25 Other (specify) Y / N / U / NA Comments        
TG4 Anyone perform triage independently and without authority? Y / N / U        
  Comments:        

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