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{"sheet":"Start HCC Exercise","index":0,"n_rows":20,"n_cols":6,"rows_kept":20,"cut":false,"hidden":false,"merged":[[0,0,0,16],[5,1,5,15],[17,1,17,15],[6,1,6,15],[19,1,19,15],[7,1,7,15],[3,1,3,15],[8,1,8,15],[18,1,18,15],[2,5,2,8]]}
["Command Center Evaluation:  Incident Commander"]
[]
[null,null,null,null,null,{"$f":"TODAY()","v":"2014-12-05"}]
[null,"You will be evaluating the hospital command center's disaster response.   You are responsible for performing the qualitative assessment items and for collecting information regarding operating room (OR) capacity, staff, and certain supplies.   Your primary point of contact should be the incident commander (IC).  You should position yourself to be near him/her throughout the exercise.  "]
[]
[null,"Instructions:   Note:  if \"Security Warning  Macros have been disabled\" appears at the top of the screen, click \"Enable Content.\"\n          1. Evaluators and trusted insiders assemble at a pre-designated place, approximately 30 minutes prior to exercise start.\n          2. Command Center evaluators (2) should be escorted to position in or near the command center.\n"]
[null,"          3. Wait in or near the command center until the IC arrives.\n          4. Review the spreadsheet.   Note the two tabs for inputting:\n                    a. Staff and supplies \n"]
[null,"                    b. Qualitative questions\n          5. As soon as the Incident Commander arrives in the command center, introduce yourselves and press the Start Exercise button and read the script below.  \n          6. The script asks the IC to identify a “bed controller.”  Direct your evaluation partner to work with him/her."]
[null,"          7. The IC will need to reply to your queries regarding ORs, staff, and supplies.  Enter those responses on the first red tab. \n          8. Throughout the exercise, observe the command center response, and fill out the qualitative questions.   Ask clarifying questions as necessary.\n          9. The exercise will end when the ED personnel arrive to the Command Center.  When this happens, inform participants that the exercise has ended.\n        10. Follow instructions in the \"Hotwash\" tab to debrief what you observed in the exercise.\n"]
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[]
[]
[]
[]
[]
[]
[null,"Hello.   [Introduce yourself and your fellow evaluator].  We are conducting a mass casualty exercise.   There are four “evaluators,” two of us here in the command center, and two in the ED.  My primary role will be to observe the overall command center activity, looking for a series of critical actions that have been deemed important in any mass casualty response.  I will be staying close to the Incident Commander throughout the exercise."]
[null,"My partner will be monitoring the movement of patients and the creation of treatment space throughout the hospital.  He or she will keep track of the hospital’s bed availability as the hospital simulates admitting patients from the ED  and transferring patients between inpatient units or discharging them home.   In this role he or she will need to be positioned near whoever is coordinating inpatient beds with the ED.  Please identify that person."]
[null,"The exercise has already started in the ED.  We will assume that all of your information regarding scenario updates and arriving patients comes to you from the ED, so you should communicate directly with them.   \n\nAs we get started, I will need to ask for a few specific pieces of information regarding the hospital’s estimates of OR capacity, staff, and certain supplies.   Can you identify someone who can work with me to provide these estimates?\n\nAt this point you should proceed as if this were a real event, but be sure to always indicate to others that this is a drill. "]

{"sheet":"Staff and Supplies","index":1,"n_rows":16,"n_cols":2,"rows_kept":16,"cut":false,"hidden":false,"merged":[[0,0,0,16],[3,1,3,15],[6,1,6,10],[7,1,7,10],[15,1,15,10],[14,1,14,10],[13,1,13,10],[11,1,11,10],[10,1,10,10],[9,1,9,10],[5,1,5,10]]}
["Command Center Evaluation:  ORs, Staff, and Inventory"]
[]
[]
[null,"Instructions:\n          Work with someone designated by the Incident Commander to answer the questions on operating rooms, staffing, and inventory of key items.\n"]
[]
[null,"How many operating rooms are currently in use (occupied)?"]
[null,"How many operating rooms are empty and immediately available?"]
[null,"How many additional operating rooms could be made available within one hour?"]
[]
[null,"How many nurses are currently working in the hospital?"]
[null,"How many physician assistants and nurse practioners are currently working in the hospital?"]
[null,"How many physicians are currently working in the hospital?"]
[]
[null,"How many ventilators are currently available?"]
[null,"How many units of O+ blood are currently available?"]
[null,"How many units of O- blood are currently available?"]

{"sheet":"Qualitative Questions","index":2,"n_rows":32,"n_cols":10,"rows_kept":32,"cut":false,"hidden":false,"merged":[[0,0,0,10],[2,1,2,9],[3,1,3,9]]}
["Command Center—Qualitative Scoring \n(Click the appropriate box to give a a mark)"]
[]
[null,"During the exercise: Click the appropriate box to give a [check] mark.\nAfter the exercise (as part of the hotwash):  Walk through each of the qualitative questions, the rating score given, and the comments."]
[null,"          1. How did the hospital perform on this question?  \n          2. What were areas of strengths and weaknesses?\n          3. How can the hospital improve in this area?"]
[]
[null,null,null,"Strongly Disagree","Disagree","Neutral","Agree","Strongly Agree","Unable to Observe","Comments"]
[null,"Immediate Activation","Made hospital-wide notification of disaster plan activation"]
[null,null,"Considered the possibility of the hospital as a secondary target of terrorism"]
[null,null,"Secured the facility in a  timely manner"]
[null,null,"Gathered needed information to ascertain the nature and scope of the event"]
[null,null,"Made a decision regarding decontamination of incoming casualties"]
[]
[null,null,null,"Strongly Disagree","Disagree","Neutral","Agree","Strongly Agree","Unable to Observe","Comments"]
[null,"Space Creation/ Usage","Prioritized clearing the ED of existing patients in advance of casualty arrivals"]
[null,null,"Had ready access to hospital census, bed availability"]
[null,null,"Initiated the process of early discharge of hospital inpatients"]
[null,null,"Designated a site dedicated to the care of \"minor\" (ambulatory) casualties"]
[]
[null,null,null,"Strongly Disagree","Disagree","Neutral","Agree","Strongly Agree","Unable to Observe","Comments"]
[null,"Move from Normal Stds","Canceled elective operations and procedure and considered expedited completion of procedures already in progress"]
[null,null,"Demonstrated an appropriate willingness to relax standards of care"]
[]
[null,null,null,"Strongly Disagree","Disagree","Neutral","Agree","Strongly Agree","Unable to Observe","Comments"]
[null,"Communication","Designated a receiving area for press and family members"]
[null,null,"Received injects given in the ED without degradation of key information"]
[null,null,"The command center has the appropriate systems and personnel needed to maintain situational awareness."]
[null,null,"The command center has backup plans in case electronic communications systems fail"]
[]
[null,null,null,"Strongly Disagree","Disagree","Neutral","Agree","Strongly Agree","Unable to Observe","Comments"]
[null,"Recruiting Resources and Recognizing Limits","Called in additional staff as necessary or to the extent possible"]
[null,null,"Considered the possible need for additional critical resources (e.g., ventilators, blood products, stretchers, and cardiac monitors) and took steps to acquire such resources as indicated"]
[null,null,"Recognized the limits of its hospital's capacity and, as appropriate, engaged in discussion with coalition and/or EMS regarding rerouting casualties"]

{"sheet":"Hotwash","index":3,"n_rows":20,"n_cols":6,"rows_kept":20,"cut":false,"hidden":false,"merged":[[19,1,19,9],[18,1,18,9],[15,1,15,9],[0,0,0,10],[4,1,4,9],[16,1,16,9],[2,1,2,9]]}
["Command Center Hotwash: Incident Commander"]
[]
[null,"Hotwash Instructions:\n1.  At the end of the exercise, the ED players and evaluators will come to the command center for the hotwash.\n2.  Review the information provided below and prepare to debrief your observations.\n3.  Each member of the evaluation team should debrief their portion of the exercise using the \"Hotwash\" tab on their respective spreadsheets.  \n          a. The suggested order is:  (1) ED Exercise Controller, (2) ED Qualitative Evaluator, (3) CC Incident Commander Evaluator (you), (4) CC Bed Control Evaluator. \n4.  When it is your turn, summarize the information you collected and lead a discussion using the questions provided on this tab."]
[]
[null,{"$f":"\"I shadowed the Incident Commander during the exercise and observed actions taken by the command center staff.  In terms of staffing, the hospital had \"&IF(nurses=\"\",0,nurses)&\" nurses, \"&IF(panp=\"\",0,panp)&\" PAs and NPs, and \"&IF(physicians=\"\",0,physicians)&\" physicians working during the exercise.  In terms of available inventory, the hospital had \"&IF(vents=\"\",0,vents)&\" free ventilators, \"&IF(oposblood=\"\",0,oposblood)&\" units of O+ blood, and \"&IF(onegblood=\"\",0,onegblood)&\" units of O- blood available for use. In terms of operating rooms, the hospital had \"&IF(ORavail=\"\",0,ORavail)&\" operating rooms initially available and \"&IF(ORavailonehour=\"\",0,ORavailonehour)&\" operating rooms that could be free within one hour.\"","v":"I shadowed the Incident Commander during the exercise and observed actions taken by the command center staff.  In terms of staffing, the hospital had 0 nurses, 0 PAs and NPs, and 0 physicians working during the exercise.  In terms of available inventory, the hospital had 0 free ventilators, 0 units of O+ blood, and 0 units of O- blood available for use. In terms of operating rooms, the hospital had 0 operating rooms initially available and 0 operating rooms that could be free within one hour."}]
[]
[null,null,null,"Nurses","PAs & NPs","Physicians"]
[null,null,"Hospital Staff",{"$f":"nurses","v":0},{"$f":"panp","v":0},{"$f":"physicians","v":0}]
[]
[null,null,null,"Free Ventilators","Units of O+ Blood","Units of O- Blood"]
[null,null,"Inventory",{"$f":"vents","v":0},{"$f":"oposblood","v":0},{"$f":"onegblood","v":0}]
[]
[null,null,null,"Initially In Use","Initially Available","Available Within One Hour"]
[null,null,"Operating Rooms",{"$f":"ORfull","v":0},{"$f":"ORavail","v":0},{"$f":"ORavailonehour","v":0}]
[]
[null,"Discussion Questions:\n          1.  How many additional staff do you think could be brought in?  How long would it take?\n          2.  Where could you obtain additional ventilators and blood?  How would that be brought in?  How long would it take?\n          3.  What other critical resources should the command center be tracking?"]
[null,"          4.  What would be required to open and staff additional ORs, if any?  What are barriers to equipping and turning around ORs quickly after an operation?\n          5.  Do you have established procedures for holding or canceling elective operations?\n          6.  Do you feel you would be engaging coalition/other hospitals for resources or transfers?  How would that occur?  "]
[]
[null,"Qualitative Assessment:\n•The evaluator will next lead a discussion on the Qualitative Questions that were on the previous tab.  \n•Walk through each of the Qualitative Questions, the rating score given, and the comments.   \n•Tell the participants that the score itself is not as important as discussing the underlying reasons for the score, and where there are opportunities for improvement."]
[null,"For each of the questions, lead a discussion:\n          1. How did the hospital perform on this question?  \n          2. What were areas of strengths and weaknesses?\n          3. How can the hospital improve in this area?"]