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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 It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work.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.

Please go to www.ahrq.gov for current information.

Pre-Drill Module

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

Section # Question Response
I. Background Information PD1 Name of person completing module  
Title  
Hospital  
Room number  
Street address  
City and State  
Office phone  
Cell phone  
E-mail  
FAX  
Pager  
Best method to contact during drill Cell phone  
E-mail  
FAX  
Office phone  
Pager  
PD2 Name of additional contact person  
Title  
Hospital  
Room number  
Street address  
City and State  
Office phone  
Cell phone  
E-mail  
FAX  
Pager  
Best method to contact during drill Cell phone  
E-mail  
FAX  
Office phone  
Pager  
PD3 Type of disaster scenario Biological  
Chemical  
Fire  
Incendiary device/explosive  
Natural disaster  
Radiation  
Structural collapse  
Transportation accident  
Internal hospital system failure (specify)  
Other (specify)  
PD4 Proposed date of drill?  
PD5 Estimated start time of drill?  
PD6 Expected length of drill?  
PD7 Will disaster drill be announced to staff prior to beginning of drill? Yes  
No  
Unclear  
II. Level and Scope of Hospital Drill Activity PD8 Format of drill Operationalized Drill  
Tabletop Exercise  
Computer Simulation  
Other (specify)  
PD9 Main overall goal  
PD10 Specific objectives a.  
b.  
c.  
d.  
PD11 Number of mock victims Paper  
Actual  
PD12 Mock victim physical identification Bar coding  
Clothing  
Victim tracking cards  
Wrist bands  
NA  
Other (specify)  
PD13 Mock victims include people with medical training? Yes, #  
No  
Unclear  
NA  
PD14 Number of "smart" casualties? #  
PD15 Triage levels for mock victims identified Color codes  
Number codes  
Other (specify)  
Other (specify)  
PD16 Mock victim meeting and preparation area Room & building (specify)  
III. Drill Activity PD17 Location of initiating event In hospital  
Where  
Out of hospital  
<1 mile  
1-5 miles  
6-10 miles  
>10 miles  
PD18 Method to notify initiation of drill By another hospital  
By first victim arrival  
By health department  
By government agency  
Other (specify)  
PD19 Hospital staff groups that will actively participate in drill activities Administration  
Central supply  
Emergency department medical staff  
Emergency medical transport service  
Engineering and physical plant  
Infection control  
Intensive care unit  
Laboratory  
Medicine  
Nursing  
Oncology  
Pediatrics  
Pharmacy  
Psychiatry  
Public affairs  
Radiology  
Security/safety  
Social work  
Surgery  
Hospital-wide  
Other (specify)  
Other (specify)  
PD20 Approximate number of hospital personnel (not including victims or observers) participating <10  
10-15  
16-50  
51-100  
101-250  
>250  
PD21 Levels of activity included in drill Materials and supplies received  
Simulated clinical procedures performed  
Triage of victims  
Victim decon simulated  
Victim transport in emergency department only  
Victim transport throughout hospital  
Other (specify)  
PD22 Activities in active patient care areas? Yes  
No  
Unclear  
PD23 Organizations/agencies involved in drill Ambulance system  
Community  
Fire  
Media  
Police  
Hospital/health system(s) (specify)  
State agency(ies) (specify)  
Federal agency (specify)  
Military (specify)  
Other (specify)  
PD24 Existing memorandum of understanding (MOU)? Yes  
No  
PD25 MOU to be activated during drill Ambulance system  
Community  
Fire  
Media  
Police  
Hospital/health system(s) (specify)  
State agency(ies) (specify)  
Federal agency (specify)  
Military (specify)  
Other (specify)  
None  
IV. Incident Command PD26 Format of disaster plan available to hospital staff Complete manual  
Flow diagram  
Job action sheets  
No disaster plan  
Other (specify)  
PD27 Incident command center activated? Yes, Location  
No  
PD28 If no Incident Command Center (ICC) how will drill be managed?  
PD29 Will incident commander and functional leaders be identified? Yes  
No  
Unclear  
PD30 Method to identify leaders Arm bands  
Hats  
Tee shirts  
Vests  
NA  
Other (specify)  
V. Communications PD31 Methods to communicate during drill 2-way radio(s)  
AM/FM radio(s)  
E-mail and Internet access  
Direct line(s)  
FAX machine(s)  
Intercom  
Landline phone(s)  
Megaphone(s)  
Numeric paging  
Overhead paging  
Runner(s)  
Television(s)  
Text paging  
Wireless/cell phone(s)  
Other (specify)  
VI. Decontamination PD32 Location of decon Ambulance ramp  
Inside the hospital  
Parking lot  
Street/road  
NA  
Other (specify)  
PD33 Decon equipment to be used Fire department owned  
Hospital owned  
Owned by another hospital  
NA  
Other (specify)  
PD34 Method to decon victims Emergency Medical Service (EMS) or fire department vehicles with hoses  
Permanent overhead showers/sprinklers  
Temporary decon tent(s)  
NA  
Other (specify)  
VII. Evaluation PD35 Zones to evaluate Decon  
Incident Command  
Treatment  
Triage  
Other (specify)  
PD36 Specific areas most important to evaluate Biological illness exposure  
Communications  
Equipment and supplies  
Information flow  
Patient documentation and tracking  
Patient flow  
Personnel  
Personal protective equipment (PPE) and safety  
Radiation exposure  
Rotation of staff  
Security  
Time points  
Zone disruption  
Zone location and boundaries  
Zone operations  
PD37 Type of observers Administration staff  
Designated hospital clinical staff  
External clinical staff  
Other designated hospital staff  
Other external experts identified  
Other external experts requested  
Other (specify)  
PD38 Approximate number of observers planned to use? #  
PD39 Expect to recruit observers from own hospital? Yes  
No  
Unclear  
PD40 Name of lead observer  
PD41 Person to conduct debriefing session  
Title  
Hospital  
Room number  
Street address  
City and State  
Office phone  
Cell phone  
E-mail  
FAX  
Pager  
Best method to contact during drill Cell phone  
E-mail  
FAX  
Office phone  
Pager  
VIII. Additional Comments PD42 Comments:  

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