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Hospital Preparedness Exercises Guidebook

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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Chapter 7. Conduct

This section provides an overview of conducting a hospital preparedness exercise in the following sections:

  • Overview: Conduct.
  • Discussion-Based Exercises.
  • Operations-Based Exercises.
  • Checklist: Conduct.
  • Useful Resources and Tools.

Overview: Conduct

The Conduct phase of a hospital preparedness exercise involves three parts:

  1. Pre-exercise activities (e.g., setup).
  2. Exercise, and
  3. Post-exercise/wrap-up activities.

The purpose of the conduct phase is to test whether or not the hospital is able to carry out capability- and task-based objectives within the constraints of the exercise scenario and other injects.

This section breaks down the HSEEP methodology for conducting an exercise into the two main types of exercises: (1) discussion-based exercises; (2) operations-based exercises.

Discussion-Based Exercises

As mentioned on page 9, there are many types of discussion-based exercises: seminars, workshops, tabletop exercises, games, models, and simulations. Discussed below is an example of a commonly used discussion-based exercise by hospitals, a tabletop exercise (TTX).

Exercise Participants

There are several types of exercise participants:

  • Players: Participants that discuss their role and response to the scenario. Players can be internal (e.g., hospital staff) or external (representatives from community agencies).
  • Evaluators: Unbiased observers that record the discussion and their observations and do not participate in the discussion.
    • Examples of evaluators include staff from other hospitals or public health institutions. These people are recruited and trained during the design and development phase.
  • Facilitators: Lead the discussion, coordinate discussion among groups, and summarize the decisions of the group on specific issues; keep the group focused on determining how critical tasks will be performed.
  • Recorders: Record discussion data and do not participate in the exercise.

Conduct of a Discussion-Based Exercise

  • Setup: TTX room setup includes where participants will be situated during the exercise, specifically who will sit at what tables and what the tables represent, labeling (table tents, name tents), and location of audiovisual equipment.
  • Presentation: In a TTX, a moderator normally conducts a briefing using a multimedia exercise presentation. The briefing provides an introduction about the exercise and informs participants of their roles and responsibilities during exercise play. This information may also be provided to players in their Situation Manuals.
  • Facilitated Discussions: TTX are first conducted in facilitated group discussions where participants are assigned seating in different groups based on the organizations they represent. A facilitator will be responsible for leading discussion, ensuring that all players have the opportunity to contribute.
  • Moderated Discussions: After the facilitated discussion, a representative from each area presents results of each component to the reassembled group, with moderation from the facilitator. Questions are also addressed. (Alternately, all discussion may take place in one large group with no breakout time set aside for small group discussion.)
  • Wrap-Up Activities: At the conclusion of both discussions, wrap-up activities take place. Documentation from the wrap-up activities is essential for the Evaluation phase. These activities include:
    • Debriefing: This meeting occurs immediately after the exercise, addresses immediate concerns or issues, and is conducted with Exercise Planning Team members.
    • Participant Feedback Forms: These are given to participants immediately following an exercise to provide their feedback of the exercise.
    • Hot Wash: A hot wash may be conducted in lieu of feedback forms or to supplement forms. A "hot wash" is an open discussion with the exercise participants and is conducted immediately after an exercise while the exercise is still "hot." The goal is to identify exercise strengths and areas to be improved.

Sample Tabletop Exercise Schedule

8:00 – 8:30 Registration
8:30 – 9:00 Session 1: Incident Presentation
9:00 – 9:30 Session 2: Notification and Mobilization
9:30 – 10:30 Session 3: Response
10:30 – 11:00 Session 4: Recovery
11:00 – 11:30 Summary and Conclusion
11:30-12:30 Wrap-Up Activities: Feedback and Hot Wash

Operations-Based Exercises

Also mentioned on page 10, there are several types of operations-based exercises: drills, functional exercises, and full-scale exercises.Hospitals may conduct all of these exercise types.

Exercise Participants

There are several types of exercise participants:

  • Players: Perform assigned health-care related roles and responsibilities during the exercises.
  • Controllers: Monitor and manage exercise play and provide participants with key information during the exercise.
  • Evaluators: Do not "play" in the exercise but rather record specific information on the actions of the players during exercise.
    • Examples of people who may be recruited as evaluators include staff from other hospitals or public health schools.
  • Actors: Volunteers or paid professionals who serve as patients or other individuals relevant to the scenario.
    • Examples of actors include hospital volunteers and medical students.
  • Observers: People who are watching the exercise, e.g., media or VIP.
  • Safety Officers: People in charge of overseeing operations safety and enforcing safety policy for exercises.

Operations-Based Exercise Conduct – Functional/Full-Scale

  • Setup: Depending on the scenario, setup should occur well before the start of an exercise. This entails designating the location for the components of the exercise (staging areas, registration, media and their perimeters), testing equipment, situating props, and checking for safety issues.
  • Briefings: Briefings need to be held prior to exercise play to ensure all participants know their roles and responsibilities. These briefings are: Safety Briefing (for all participants), Controller and Evaluator Briefing, Player Briefing, Actor Briefing, and Observer Briefing. Exercise play rules should also be established prior to the exercise as safety precautions (including protocols for termination mid-exercise).
  • Exercise Play: This is when the exercise is carried out. It is essential to have an exercise controller responsible for making key announcements regarding the start and end of the exercise. The exercise generally lasts until time allotted for the exercise expires, or until all objectives are met.
  • Wrap-Up Activities: At the conclusion of exercise play, wrap-up activities take place. Documentation from the wrap-up activities is essential for the Evaluation phase. These activities include:
    • Hot Wash: Also called a participant debriefing, a participant hot wash is an open-forum discussion with exercise players and other participants. This occurs immediately after the exercise, and is used to solicit feedback from exercise participants. They may also submit a Participant Feedback form during this time. Hot Wash Minutes should be recorded from this meeting.
    • Controller and Evaluator Debrief: This is a debriefing for controllers and evaluators to express their feedback regarding the exercise. Controllers and evaluators will also finish and submit their Exercise Evaluation Guides.

Checklist: Conduct

The following are some of the essential steps in the Conduct phase:

Discussion-Based Exercise

  • Room setup.
  • General briefing presentation.
  • Exercise play—presentation of scenario and discussion.
  • Debriefing with exercise planning team.
  • Hot wash and/or participant feedback forms.

Operations-Based Exercise

  • Set-up of location—designating areas for registration, observation, etc.
  • Safety briefing for all participants.
  • Individual briefings for controllers and evaluators, players, actors, and observers.
  • Exercise play.
  • Player hot wash.
  • Controller and Evaluator debrief.

Useful Resources and Tools

Below is a list of useful resources and tools related to conducting hospital preparedness exercises broken down by discussion-based exercises and operations-based exercises.

Discussion-Based Exercises

  • Hot Wash Minutes (HSEEP Vol. IV*, see under Conduct)
    This is a template to record minutes from a hot wash/participant debrief meeting, including expectations, outcomes and issues that participants identified during the exercise.
  • Participant Feedback Form (HSEEP Vol. IV, see under Conduct)
    This sample form allows participants to provide feedback on exercise design and conduct and make recommendations for improvement.

Operations-Based Exercises

  • Actor, Player, Controller & Evaluator, Hospital, and Observer Briefings (HSEEP Vol. IV, see under Conduct > Exercise Briefings)
    These presentations may be used during briefing meetings with groups of exercise participants to give them essential information about the exercise and their roles in the exercise.
  • Hospital Debrief (HSEEP Vol. IV, see under Conduct > Exercise Briefings)
    This presentation is used to discuss the exercise with, and solicit feedback from, hospital exercise participants after the exercise.
  • Controller & Evaluator Debrief (HSEEP Vol. IV, see under Conduct > Exercise Briefings)
    This presentation is for a post-exercise debrief with controllers and evaluators to discuss the exercise and do a preliminary analysis of the information collected.
  • Exercise Weapons Policy (HSEEP Vol. IV, see under Program Management > Policies
    This is an example of a safety policy used during an exercise when there are weapons involved.

*Note: These can be found as part of the HSEEP Volume IV Library: Sample Exercise Materials under Exercise Planning.

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