Skip Navigation U.S. Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner
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 It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work.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.

Triage 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
C3. Time this zone was ready to accept victims: (Circle one) _____________ AM / PM / U
C4. Time when this zone was notified that incident command was operational: (Circle one) _____________ AM / PM / U / Not initiated
C5. Time the drill ended in this zone: (Circle one) _____________ AM / PM / U
TG1. Time first victim arrived in the triage zone: (Circle one) _____________ AM / PM / U

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

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):
________________________________

C10. Were providers able to move easily through this zone?

Y / N / U

TG2. Was the triage zone contiguous to or located in the emergency department (ED)? Y / N / U
TG3. If the triage zone was not contiguous to the emergency department, estimate distance away in feet:________________________________

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

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

C16-18. How many hospital drill participants were initially assigned to this zone? (Give approximate numbers)

C16. Physicians: __________________
C17. Nurses: __________________
C18. Ancillary personnel (registrars, security, cleaning staff, etc.):
__________________
C19. Were additional drill participants added during the drill?

Y / N / U

C20-22. If additional zone staff were added during the drill, what were their approximate numbers? (Leave blank if not applicable)

C20. Physicians: __________________
C21. Nurses: __________________
C22. Ancillary personnel (registrars, security, cleaning staff, etc.):
__________________
TG4. Did anyone perform triage independently and without authority? Y / N / U

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

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):
________________________________

C33. Did clinical staff interact directly with families of victims?

Y / N / U / NA

C34. Were families of victims referred to specially designated staff? Y / N / U / NA

C35. How was victims' privacy ensured?(Check all that apply)

a. [  ] Curtains
b. [  ] Individual areas
c. [  ] Privacy screens
d. [  ] Not ensured
e. [  ] Other (specify):
________________________________

TG5. What proportion of victims were screened for biological OR chemical OR radiation exposure before entry into the triage area? (Check one)

O None
O Less than half
O At least half (but not all)
O All
O Unclear

TG6. If victims were screened for biological, chemical, or radiation exposure, how were they screened? (Check all that apply)

a. [  ] Personal interview
b. [  ] Physical examination
c. [  ] Screening device
d. [  ] Not screened
e. [  ] NA
f.  [  ] Other (specify):
________________________________

TG7. What proportion of victims in the triage zone received care beyond basic airway maneuvers and control of active bleeding? (Check one)

O None
O Less than half
O At least half (but not all)
O All
O Unclear

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

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):

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

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):
________________________________

C56. Did your zone receive updates regarding the situation outside the hospital
(e.g., status of disaster events, number of victims arriving, acuity of victims)?

Y / N / U

C57. If your zone received regular updates, who sent them? (Check all that apply)

a. [  ] City/State health department
b. [  ] Emergency Medical System
c. [  ] Incident command center
d. [  ] Media
e. [  ] State disaster agency
f.  [  ] Did not receive
g. [  ] Other (specify):
________________________________

C58. How was this zone kept aware of the ongoing general situation within the hospital? (Check all that apply)

a. [  ] Call(s) from incident command
b. [  ] FAX from incident command
c. [  ] Other contact from incident command
d. [  ] Runner(s) from incident command
e. [  ] Contact from other internal sources (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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

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):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

Victim Documentation and Tracking

Question Response

C74. Were all incoming victims registered and given a unique identification or medical record number? (Check one)

O Yes, before entering this zone
O Yes, on entering this zone
O No, not while in this zone
O Unclear

C75. What was the method of documenting the victim record in this zone? (Check all that apply)

a. [  ] Computer entry
b. [  ] Data card(s) attached to victims
c. [  ] Dictation system
d. [  ] Personal data assistant (PDA)
e. [  ] Scanner
f.  [  ] Separate victim paper chart
g. [  ] No documentation
h. [  ] Other (specify):
________________________________

C76. Was a central list of victims generated for this zone?

Y / N / U

C77. Were the triage markers on the victims clearly visible? Y / N / U

C78. Did the triage markers stay affixed to the victims while in this zone?

Y / N / U / NA

C79. Was clinical information about victims accessible to caregivers? Y / N / U / NA

C80. What proportion of victims arriving in this zone were labeled with a triage level? (Check one)

O None
O Less than half
O At least half (but not all)
O All
O NA

TG8. Did the hospital have a method for expedited registration and/or medical record documentation?

Y / N / U

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

Victim Flow

Question Response

C81. Did a bottleneck develop in this zone?

(If a bottleneck did develop, describe in the comment box at the end of this section.)

Y / N / U

C82. What was the maximum number of victims observed waiting at the bottleneck at any time? (Check one)

O 0
O 1-10
O 11-25
O 26-50
O 51-100
O > 100
O Unclear

C83. Was the bottleneck resolved?

(If the bottleneck was resolved, describe in the comment box at the end of this section.)

Y / N / U / NA

C84. Were the paths leading to the next zone marked?

Y / N / U

C85. If the paths were not marked, were verbal directions given by zone staff? Y / N / U / NA

C86. Were the lowest acuity victims directed by staff to an area separate from higher acuity victims?

Y / N / U

C87. What proportion of victims had treatment delayed because of zone staffing shortage? (Check one)

O None
O Less than half
O At least half (but not all)
O All
O NA

C88. Were expiring victims placed in a quiet and separate place?

Y / N / U / NA

C89. Were deceased victims rapidly removed from this zone? Y / N / U / NA

C90. How many victims passed through this zone? (Check one)

O 0
O 1-10
O 11-25
O 26-50
O 51-100
O > 100
O Unclear

TG9. Did any contaminated victims enter this zone?

Y / N / U / NA

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

Personal Protective Equipment (PPE) and Safety

If needed, were these items for standard precautions available for the health care workers?

If safety materials were not available, circle "N" in column "a" and go to the next row.

Safety Materials a. Available? b. Used by staff? c. Adequate Supply?
C91. Eye protection Y / N / U Y / N / U Y / N / U
C92. Waterproof gowns Y / N / U Y / N / U Y / N / U
C93. Isolation gowns Y / N / U Y / N / U Y / N / U
C94. Gloves Y / N / U Y / N / U Y / N / U
C95. Other (specify): _______________ Y / N / U Y / N / U Y / N / U
C96. Other (specify): _______________ Y / N / U Y / N / U Y / N / U
C97. Other (specify): _______________ Y / N / U Y / N / U Y / N / U

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

Equipment and Supplies

Were these medical supplies available?

If the medical supplies were not available, circle "N" in column "a" and go to the next row.

Medical Supplies a. Available b. Issues
TG10. Bandages Y / N / U / NA  
TG11. Basic airway equipment Y / N / U / NA  
TG12. Blood pressure equipment Y / N / U / NA  
TG13. Oxygen masks Y / N / U / NA  
TG14. Oxygen tanks Y / N / U / NA  
TG15. Splints Y / N / U / NA  
TG16. Stethoscopes Y / N / U / NA  
TG17. Stretchers Y / N / U / NA  
TG18. Suction equipment Y / N / U / NA  
TG19. Surgical masks Y / N / U / NA  
TG20. Vascular access supplies (catheters, fluids, etc) Y / N / U / NA  
TG21. Wheelchairs Y / N / U / NA  
TG22. Other (specify):
________________________________
Y / N / U / NA  
TG23. Other (specify):
________________________________
Y / N / U / NA  
TG24. Other (specify):
________________________________
Y / N / U / NA  

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

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):

 

 

 

 

 

 

 

 

 

 

 

 

 

Return to Contents

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):
________________________________

C106. If the zone closed during the drill, was the incident command center notified?

Y / N / U

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

   C110. Was the incident command center notified when 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):

 

 

 

 

 

 

 

 

 

 

Return to Contents
Proceed to Next Section

 

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care