2019 ndltca tabletop exercise – active shooter · 2019. 9. 18. · scenario in the modules of how...

Rev. April 2013 HSEEP-IP01

2019 NDLTCA Tabletop Exercise – Active Shooter After-Action Report/Improvement Plan September 18th, 2019 Prepared By: Matt Nelson Consultant, Owner Hazard Cycle Consulting LLC

The After-Action Report/Improvement Plan (AAR/IP) aligns exercise objectives with preparedness doctrine to include the National Preparedness Goal and related frameworks and guidance. Exercise information required for preparedness reporting and trend analysis is included; users are encouraged to add additional sections as needed to support their own organizational needs.

After-Action Report/ LTC Community Table Top Exercise Improvement Plan (AAR/IP) Holiday Inn Fargo

Exercise Overview 1 Fargo Cass Public Health [PROTECTIVE MARKING, AS APPROPRIATE]

Homeland Security Exercise and Evaluation Program (HSEEP)

EXERCISE OVERVIEW

Exercise Name 2019 Longterm Care Tabletop – Active Aggressor

Exercise Dates September 18th, 2019

Scope This exercise is a Tabletop Exercise planned for 1.5 hours at the Holiday Inn in Fargo, ND

Mission Area(s) Prevention, Mitigation, Response, and/or Recovery

Core Capabilities

Emergency Operations Coordination, Public Information and Warning

Mass Care, Responder Safety & Health, Incident Command System.

Objectives

1. Complete Table Top Exercise i. Discuss the scenario in the modules of how the

situations impact your facility ii. Discuss Internal Communication Systems

iii. Discuss External Communication Systems iv. Discuss Security Strengths and Weaknesses v. Discuss process for Evacuation/Sheltering of residents

(run-hide-fight/ALICE) vi. Establish preliminary objectives for an improvement

plan

Threat or Hazard Active Aggressor/Killer

Scenario

Overview This exercise is intended to provide the credit necessary for the CMS requirements as a community based exercise for the tabletop and full-scale exercise. The tabletop exercise will take place in the morning of September 18th, 2019 starting at 8am. There has been a domestic dispute at your facility that has progressed into a hostile situation. One of the involved people works as a Nurse in your facility. The dispute started as an altercation between the nursing employee and their sibling regarding the treatment of their father who is also at your facility. The situation progressively got worse until the sibling of your employee decided to use acts of violence to fulfill the fathers wishes and break out from your facility. Ultimately, the situation ended with the sibling bringing a firearm into your




facility and killing an employee, the sister (also your employee) and ended with a murder suicide of the father and shooter. It was later found out that this was a planned event that would end with the father and sibling ending their lives. During the event, the sibling disabled the power and backup generator to create chaos and to disarm the access doors to escape the building. The result was that you now have a facility without power and no backup. Law Enforcement has contained the situation but you now have your residents in your facility with no power. You must work with the NDDOH, NDDES, your local health department, and neighboring facilities to find a solution. Objectively you must deal with security issues by working with the law enforcement then complete the discussion regarding sheltering the residents, your employees, and eventually evacuating them to another facility.

Sponsor North Dakota Long Term Care Association

Participating Organizations

Fargo Cass Public Health

North Dakota Department of Health – Emergency Preparedness

North Dakota Long Term Care Association

Central Valley Health District

Elim Care – Fargo

Good Samaritan Society – Bottineau

Bethany – Fargo

Villa Maria – Fargo

Rosewood on Broadway – Fargo

Eventide Heartland – Devils Lake

Benedictine Living Community-Wahpeton

Benedictine Living Community-Garrision

Good Samaritan Society – Devils Lake

Good Samaritan Society – Arthur

Sheyenne Care Center – Valley City

Maple Manor Care – Langdon

Manor Care – Fargo

Sienna Court Assisted Living – Wahpeton

Eventide – Jamestown




Eventide – Fargo Hatton Prairie Village

Sunset Drive – A Prosperous Community

Towner County Living Center

Nelson County Health System

Open Door Center

Elim Care – Fargo

Strasburg Care Center

Bethel Lutheran Nursing Home and Rehabilitation

Griggs County Care Center

Northwood Deaconess Healthcare

North Star Manor

Hilltop Home of Comfort

Valley Senior Living

Golden Acres Manor

Ave Maria Village

Ethos Home Care and Hospice

St. Benedict Health

Rolette Community Care

The Meadows

Lutheran Sunset Home

The Leach Home

Ashley Medical Center

St. Aloisius Medical Center

Napoleon Care Center

Edgewood Vista – Fargo

Wishek Living Center

Point of Contact

Matt Nelson, Consultant - Owner

Hazard Cycle Consulting

218-779-6125


Analysis of Core Capabilities 4 Fargo Cass Public Health [PROTECTIVE MARKING, AS APPROPRIATE]


ANALYSIS OF CORE CAPABILITIES Aligning exercise objectives and core capabilities provides a consistent taxonomy for evaluation that transcends individual exercises to support preparedness reporting and trend analysis. Table 1 includes the exercise objectives, aligned core capabilities, and performance ratings for each core capability as observed during the exercise and determined by the evaluation team.

Objective Core Capability Performed

without Challenges

(P)

Performed with Some Challenges

(S)

Performed with Major Challenges

(M)

Unable to be

Performed (U)

1.Discuss the Scenario in the modules of how the situations impact your facility

Emergency Operations Coordination, Incident Command System

S

2. Discuss internal and external communications

Emergency Preparedness and Response, Emergency Communications, Public Information and Warning

P

3. Discuss Security Strengths and weaknesses

Emergency Preparedness and Response, Responder Safety and Health, Incident Command System

P

4. Discuss process for Evacuation/Sheltering of residents (Run-hide-fight, ALICE)

Mass Care, Emergency Operations Coordination

S

Ratings Definitions: • Performed without Challenges (P): The targets and critical tasks associated with the core capability were

completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws.

• Performed with Some Challenges (S): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. However, opportunities to enhance effectiveness and/or efficiency were identified.

• Performed with Major Challenges (M): The targets and critical tasks associated with the core capability were completed in a manner that achieved the objective(s), but some or all of the following were observed: demonstrated performance had a negative impact on the performance of other activities; contributed to additional health and/or safety risks for the public or for emergency workers; and/or was not conducted in accordance with applicable plans, policies, procedures, regulations, and laws.

• Unable to be Performed (U): The targets and critical tasks associated with the core capability were not performed in a manner that achieved the objective(s).


Analysis of Core Capabilities 5 Fargo Cass Public Health [PROTECTIVE MARKING, AS APPROPRIATE]


Table 1. Summary of Core Capability Performance

The following sections provide an overview of the performance related to each exercise objective and associated core capability, highlighting strengths and areas for improvement.

After-Action Report/ LTC Community Based Table Top Exercise Improvement Plan (AAR/IP) Public Safety Building

Appendix A: Improvement Plan A-1 Fargo Cass Public Health [PROTECTIVE MARKING, AS APPROPRIATE]


Complete Table Top Exercise The strengths and areas for improvement for each core capability aligned to this objective are described in this section.

Core Capability: Emergency Operations Coordination, Incident Command System

1. Discuss the Scenario in the modules of how the situations impact your facility. The full capability level can be attributed to the following strengths:

Strength 1: All participants in the table top had opportunity to participate and provide input.

Strength 2: The administrators present were able to give examples of how this situation impacted their facility and who would be in charge of different responsibilities.

Strength 3: The various facilities were able to discuss their culture of preparedness and how an active aggressor/killer would impact their facility.

Areas for Improvement

The following areas require improvement to achieve the full capability level:

Area for Improvement 1: Multiple organizations did not have a clear procedure or policy to address the actions that staff and residents should take.

Reference: Open discussion notes.

Analysis: The majority of facilities present, have not practiced or put in place a procedure of how to respond to an active threat. Many of the facilities are busy with day-to-day operations where there isn’t time or the resources to be able to appropriately implement procedures and practice them with drill and exercises.

Area for Improvement 2: Many Long Term Care facilities do not have training regarding active threats.

Reference: Survey Results from the table top exercise.

Analysis: Many of the Long Term Care facilities are busy with day-to-day operations. The long term care industry is highly regulated and most of the roles people have in the facilities wear “multiple hats” already. This situation makes planning and training for emergencies with a formal process difficult and often times an afterthought. The reason for this is that many long-term care facilities




do not have a designated “Emergency Manager” or “Emergency Preparedness” specialist who can plan and develop training for them. For most LTC’s the cost of hiring an employee is not reasonable. This may be the reason for the some gaps in the emergency operation plans. With active engagement with resources and information from the North Dakota Department of Health, and Local Public Health agencies and Local Law Enforcement, it should give the LTC’s the guidance to fill the gaps necessary for an effective Emergency Operations Plan.

Core Capability: Emergency Preparedness and Response, Emergency Communications, Public Information and Warning

1. Discuss Internal and External Communications

The full capability level can be attributed to the following strengths:

Strength 1: All exercise participants were able to discuss the process of communicating their process of evacuation and trigger points of when to activate their emergency procedures.

Strength 2: All participants were given guidance on how to access the NDDOH HAN Asset and HC Standard systems to request help for evacuation procedures. Many of them were familiar with the systems already.

Strength 3: Many of the facilities had procedures in place to communicate with local law enforcement, emergency responders, and other response agencies.



Area for Improvement 1: Many of the facilities did not have a Continuity of Operations plan in place.

Reference: Attendance List of Participants – Attached.

Analysis: Many of the participants did not know precisely who would fill the roles if management or administration were not present. Many relied on the charge nurse for making decisions; however, this may be a gap if the situation occurs because of the large responsibilities the charge nurses already have. It was discussed having a clear continuity plan so all staff know and understand each others’ responsibilities.




Core Capability: Emergency Preparedness and Response, Responder Safety and Health, Incident Command System

1. Discuss Security Strengths and Weaknesses


Strength 1: All exercise participants were able to discuss their strengths and weaknesses, which resulted in many facilities learning from each other.

Strength 2: All participants were able to discuss the effect an active threat would have and what resources they currently have to be able to respond to such an event.

Strength 3: Many of the facilities had procedures in place to communicate with local law enforcement, emergency responders, and other response agencies.



Area for Improvement 1: Many of the facilities did not have an Active Aggressor/Killer/Threat procedure in place.


Analysis: The facilities present showed an extensive knowledge base of their facility and how an active killer or threat would effect their facility and community. It was impressive how many facilities showed ingenuity by taking their current plans and adopting them into the current scenario. This resulting in the participants understanding that they are more prepared than what they originally perceived; however, the lack of having a procedure for staff to follow will ultimately be detrimental to the response in an active aggressor or threat.




Core Capability: Mass Care, Emergency Operations Coordination

1. Discuss Evacuation/Sheltering of residents (run-hide-fight, ALICE)


Strength 1: All exercise participants were able to discuss the their process of evacuation and sheltering with trigger points of when to activate their emergency procedures.

Strength 2: All facilities were able to discuss how the Run-hide-fight and ALICE systems of response to an Active Threat or Killer would be utilized in their facility.

Strength 3: All of the facilities had procedures in place to evacuate and shelter.



Area for Improvement 1: Many of the facilities did not have actual training with their staff of the Run-hide-fight and ALICE systems of responding to an Active Threat or killer.


Analysis: Many of the participants discussed how they have not had training in these systems. During the discussions, many of the facilities came up with new ideas and preliminary procedures of how to accomplish these tasks without a lot of fiscal investment for equipment and training. Also, many of the facilities stated they are reaching out to their local law enforcement agencies for training and techniques that they can use in their communities.




APPENDIX A: IMPROVEMENT PLAN This IP has been developed specifically for the attending facilities to the NDLTC Table Top

Core Capability Issue/Area for Improvement Corrective Action Capability

Element1 Primary Responsible

Organization Organization

POC Start Date Completion Date

Core Capability: Emergency Operations Coordination, Incident Command System

1. There were questions on job action duties and who’s responsible for what during an emergency.

Provide the LTC community with training opportunities for ICS.

Planning Training

Public Health Unit NDDOH/NDLTCA Local Law Enforcement

Core Capability: Emergency Preparedness and Response, Emergency Communications, Public Information and Warning

1. Many of the facilities did not have a Continuity of Operations plan in place.

Have more opportunity for LTC facilities to take training and workshops on continuity of operations.

Planning Training

Public Health/NDDOH/NDLTCA Local law enforcement


Appendix B: Exercise Participants B-1 Fargo Cass Public Health [PROTECTIVE MARKING, AS APPROPRIATE]


APPENDIX B: EXERCISE PARTICIPANTS Participating Organizations

Federal State

Core Capability: Emergency Preparedness and Response, Responder Safety and Health, Incident Command System

1. Many of the facilities did not have an Active Aggressor/Killer/Threat procedure in place.

Have more opportunity for LTC facilities to take training and workshops on writing policy and procedures.

Planning Training


Core Capability: Mass Care, Emergency Operations Coordination

1. Many of the facilities did not have actual training with their staff of the Run-hide-fight and ALICE systems of responding to an Active Threat or killer.

.

Have more opportunity for LTC facilities to take training and workshops on the Run-hide-fight and ALICE systems of response to active killer and active aggressor threats.

Planning Training





NDDOH – North Dakota Department of Health Local Fargo Cass Public Health Lake Region District Public Health Unit Central Valley Public Health Unit [Jurisdiction B]

Elim Care – Fargo

Good Samaritan Society – Bottineau

Bethany – Fargo

Villa Maria – Fargo

Rosewood on Broadway – Fargo

Eventide Heartland – Devils Lake

Benedictine Living Community-Wahpeton

Benedictine Living Community-Garrision

Good Samaritan Society – Devils Lake

Good Samaritan Society – Arthur

Sheyenne Care Center – Valley City

Maple Manor Care – Langdon

Manor Care – Fargo

Sienna Court Assisted Living – Wahpeton

Eventide – Jamestown

Eventide – Fargo

Hatton Prairie Village

Sunset Drive – A Prosperous Community

Towner County Living Center

Nelson County Health System

Open Door Center

Elim Care – Fargo

Strasburg Care Center

Bethel Lutheran Nursing Home and Rehabilitation

Griggs County Care Center




Northwood Deaconess Healthcare North Star Manor

Hilltop Home of Comfort

Valley Senior Living

Golden Acres Manor

Ave Maria Village

Ethos Home Care and Hospice

St. Benedict Health

Rolette Community Care

The Meadows

Lutheran Sunset Home

The Leach Home

Ashley Medical Center

St. Aloisius Medical Center

Napoleon Care Center

Edgewood Vista – Fargo Wishek Living Center




APPENDIX C: HSEEP SURVEY RESULTS

2019 ndltca tabletop exercise – active shooter · 2019. 9. 18. · scenario in the modules of how...

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