Ebola ConOps Template Exercise Guide

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Exercise Guide forEbola Concept of Operations(ConOps) PlanningApril, 2016

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Exercise Guide for Ebola Concept of Operations PlanningAcknowledgmentsListed below are the agencies, departments, and associations that helped to develop this tool.Workgroup Members and Subject Matter ExpertsU.S. Department of Health and Human ServicesAssistant Secretary for Preparedness and ResponseOffice of Emergency ManagementHospital Preparedness ProgramOffice of Policy and PlanningDivision of Health Systems PolicyU.S. Department of Health and Human ServicesCenters for Disease Control and PreventionOffice of Public Health Preparedness and ResponseDivision of State and Local ReadinessNational Center for Emerging and Zoonotic Infectious DiseasesDivision of Healthcare Quality PromotionDivision of Preparedness and Emerging InfectionsOffice of Public Health Scientific ServicesCenter for Surveillance, Epidemiology and Laboratory ServicesAdministrative SupportOak Ridge Associated UniversitiesOak Ridge Institute for Science and EducationReviewersAssociation of State and Territorial Health OfficialsNational Association of State Emergency Medical Services OfficialsNational Association of County and City Health OfficialsAcknowledgementsi

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Exercise Guide for Ebola Concept of Operations PlanningTable of ContentsChapter 1 – Introduction . 11.1. What is Included in this Guide . 11.2. Definitions . 21.3. Target Audience . 21.4. Providing Feedback . 3Chapter 2 – Exercise Design, Conduct, and Evaluation . 52.1. Exercise Design . 5Roles and Responsibilities . 5Documentation. 6Desired Outcomes. 62.2. Exercise Conduct. 7Facilitated vs. Moderated Discussion . 7Wrap-Up Activities. 7Logistics. 7Virtual Exercise Considerations . 82.3. Exercise Evaluation . 8Evaluation Steps . 8Lessons Learned and Corrective Actions . 9Reports and Improvement Planning . 11Timeline . 12Chapter 3 - Overview of Exercises in this Publication . 133.1. Ebola Discussion-Based Exercise Overview . 13Table of Contentsiii

Exercise Guide for Ebola Concept of Operations Planning3.2. Design and Development . 14Goals and Objectives . 14Scenarios and Key System Elements. 15Participants . 16Chapter 4 – Exercise Modules . 194.1. Module Overview . 194.2. Part I – Modules Focused on Plan Elements . 22Module 1: Public Health Monitoring and Movement . 22Module 2A: EMS Preparation and Support at the Local Level for the Transport of PUIs orPatients Confirmed with Ebola . 26Module 2B: EMS Preparation and Support at the Jurisdictional Level for the Transport ofPUIs or Patients Confirmed with Ebola . 29Module 3: Waste Management Considerations . 32Module 4: Laboratory Services Support and Coordination . 344.3.Part II – Tabletop Exercise Modules . 36Module 5: Jurisdiction Tabletop Exercise . 36Module 6: Regional (Interstate) Tabletop Exercise . 39Conclusion . 42Appendix A: Smart Objectives Worksheet . 44Appendix B: Sectors and Subsectors Involved in an Ebola Response . 46Appendix C: Exercise Participant Contact List Template . 48Appendix D: Example Ebola Scenario Topics . 50Appendix E: Master Scenario Events List Example . 52Appendix F: Example Exercise Planning Timeline . 56Table of Contentsiv

Exercise Guide for Ebola Concept of Operations PlanningAppendix G: Evaluation Steps . 60Appendix H: Participant Feedback Form Template . 62Appendix I: Tabletop Exercise Evaluation Guide Template . 66Appendix J: Corrective Action Plan Worksheet . 71Appendix K: Corrective Action Plan Template . 73Appendix L: Summary Template for a Tabletop Exercise (TTX) . 75Appendix M: Acronyms . 77Appendix N: Definitions . 79Table of Contentsv

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Exercise Guide for Ebola ConOps PlanningChapter 1 – IntroductionThis Exercise Guide for Ebola ConOps is a tool to aid planners in creating exercises to test EbolaConcept of Operations (ConOps). The purpose of the guide is to Provide recommendations for the development of smaller exercises to evaluate keysystem elements in an Ebola ConOps plan and larger exercises to evaluate the overallplan. Provide templates, scenarios, tools, and examples to facilitate the development of anEbola ConOps plan exercise. Provide considerations for evaluating an Ebola ConOps plan exercise. Describe ways to incorporate evaluation data to improve an Ebola ConOps plan.Also available is the Discussion Guide for Ebola ConOps, which is designed to aid in engagingpartners to help develop their Ebola ConOps plan. The partners involved in that process may bethe same as those participating in these exercises and the exercise process can validate theirplanning efforts.1.1. What is Included in this GuideThis guide provides recommendations on how jurisdictions can develop, conduct, and evaluatediscussion-based exercises related to their Ebola ConOps plan. The chapters included in theguide are described below.1 Chapter 1 provides information on the guide such as definitions, target audience,cooperative agreement, exercise requirements, and ways to provide feedback on theguide. Chapter 2 provides a short overview of elements needed for the design, conduct, andevaluation of any exercise.1 Chapter 3 provides a more focused overview of exercise material and includesinstructions on objective and scenario development.For more information on exercise guidelines, refer to the Homeland Security Exercise and Evaluation Program(HSEEP) at 14-25045-8890/hseep apr13 .pdf.Chapter 1 – Introduction1

Exercise Guide for Ebola ConOps Planning Chapter 4 provides six exercise modules, including a series of four discussion-basedexercises and two tabletop exercises (TTXs). Appendices provide examples of exercise templates, worksheets, as well as a listing ofacronyms and definitions.The modules in the first part of Chapter 4 include material to aid in developing a series ofsmaller exercises involving partners at the state level to help evaluate select key system elementsin an Ebola ConOps plan. Lessons learned and findings from these modules are incorporated intoplanning for the TTX modules. The TTXs include key jurisdictional-level participants as well aslocal (e.g., city, county)-level participants.1.2. DefinitionsThe following terms are used throughout this document: ConOps: A conceptual overview of the processes and steps for the proper functioning ofa system or for the proper execution of an operation. This overview also can includeresponsibilities and authorities, available resources, and methods to improvecommunications and coordination. Exercise Participant2: All levels of personnel involved in the exercise, includingpolicymakers, coordination and operations personnel, and field personnel. Jurisdiction: For the purpose of this document, this term refers to the state, local (city,county), territorial, and major metropolitan area awardees that receive funds through theEpidemiology and Laboratory Capacity for Infectious Diseases (ELC), Public HealthEmergency Preparedness (PHEP), and Hospital Preparedness Program (HPP) cooperativeagreements. Sector: Agencies, organizations, or entities that serve the same general purpose in thecommunity (e.g., the healthcare sector consists of those that provide healthcare services,including hospitals, clinics, and long-term care).1.3. Target AudienceThe target audience for this guide is personnel who have a primary role in preparedness orresponse planning. An assumption made in this document is that its readers are part of a2For the purposes of this guide, exercise participant and exercise player are used interchangeably.Chapter 1 – Introduction2

Exercise Guide for Ebola ConOps Planningjurisdiction (as defined in 1.2 above), have completed an Ebola ConOps plan, and have identifiedkey partners3 involved in Ebola ConOps planning to participate in exercises.1.4. Providing FeedbackFeedback about the Exercise Guide for Ebola ConOps Planning can be sent tohealthcareprepared@cdc.gov.3Key partners can be identified by use of the Discussion Guide for Ebola ConOps Planning, which can be found la-discussion-guide.pdf.Chapter 1 – Introduction3

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Exercise Guide for Ebola ConOps PlanningChapter 2 – Exercise Design, Conduct, and EvaluationThis chapter provides guidance on using the Homeland Security Exercise and EvaluationProgram (HSEEP) methodology, including additional information on exercise design, conduct,and evaluation. The guidance provided is not intended to be inclusive of all relevant informationneeded to plan an exercise. This chapter is also intended for those who are not familiar withdeveloping exercises; those more familiar can move on to Chapter 3. For more information aboutHSEEP methodology, refer to https://hseep.preptoolkit.org/.2.1. Exercise DesignRoles and ResponsibilitiesAccording to HSEEP guidance, participants perform specific roles and responsibilities during anexercise. The table below outlines the types of participant roles and responsibilities that are mostrelevant to a discussion-based exercise.Participant Roles and ResponsibilitiesRoleResponsibilityExercise ParticipationExercise DirectorOversees all exercise functions, including conduct,briefings, debriefings, setup, and cleanup.PassiveLead EvaluatorPart of planning team and oversees exercise evaluators.May be sole evaluator in smaller exercises.PassiveEvaluatorObserves, captures unresolved issues, and analyzesexercise results.PassiveFacilitatorKeeps discussions relevant to exercise objectives andensures all objectives and issues are discussed asthoroughly as possible.ActiveObserverObserves the exercise as it takes place and may supportplayers by asking relevant questions.Passive or SomewhatActivePlayer*Discusses his or her role and responsibilities inpreventing, responding to, or recovering from theEbola risks and hazards presented in the scenario.ActiveScribeKeeps a written record of all discussions that take placeduring the exercise (in addition to evaluator notes).Passive* At a minimum, public health, healthcare, emergency management, EMS and fire/rescue should participate asplayers in the exercise.Chapter 2 – Exercise Design, Conduct, and Evaluation5

Exercise Guide for Ebola ConOps PlanningDocumentationAccording to HSEEP guidance, comprehensive and organized documentation for exercises iscrucial to ensuring critical issues, lessons learned, and corrective actions are appropriatelycaptured to support improvement efforts (see section 2.3 Exercise Evaluation for moreinformation on evaluation and improvement planning). The documentation most relevant todiscussion-based exercises, such as the exercise series and TTX, are: Situation Manual (SitMan) Facilitator Guide Multimedia Presentation Master Scenario Events List (MSEL)4 (optional) Participant Feedback Form5Refer to HSEEP guidance for more information on how to develop and use these documents.Desired OutcomesThe purpose of determining desired outcomes is to better articulate what players are expected toknow and do as a result of their involvement in an Ebola response. Player knowledge and actionsshould mirror what is outlined in the Ebola ConOps plan. Desired outcomes differ for eachexercise. Desired outcomes should be realistic and appropriate responses to the scenario, beobserved during the conduct of an exercise, and meet exercise objectives.Desired outcomes are designed to: Assess response planning. Reinforce exercise objectives. Serve as guidance for facilitators and evaluators during the conduct of an exercise.In order to identify desired outcomes, jurisdictional planners should first identify what they wantplayers to know, understand, and be able to do. During an exercise, facilitators can ask questionsrelated to each desired outcome to test player understanding of the functional roles and4An example MSEL is provided in Appendix F.5An example Participant Feedback Form is provided in Appendix IChapter 2 – Exercise Design, Conduct, and Evaluation6

Exercise Guide for Ebola ConOps Planningresponsibilities. These questions should relate directly to the desired outcome and also align withexercise objectives. Chapter 3 includes questions to achieve desired outcomes in each of theexercise modules.2.2. Exercise ConductFacilitated vs. Moderated DiscussionAccording to HSEEP guidance, discussion-based exercises typically work best throughfacilitated or moderated discussions. Facilitated discussions occur in a plenary session or inbreakout groups that are typically organized by discipline or agency/organization. Moderateddiscussions generally follow breakout group discussions where a representative from each groupprovides participants with a summary of their facilitated discussion.Whether the exercise is facilitated or moderated, or both, the facilitator is responsible for keepingdiscussion relevant to exercise objectives. The facilitator also is responsible for ensuring allobjectives and issues are discussed as thoroughly as possible and for ensuring relevant discussionquestions are asked in order to gather information for desired outcomes.Wrap-Up ActivitiesWrap-up activities after exercise conduct may include player hot washes and debriefings. Playerhot washes are essential to successful exercise conduct. They provide an opportunity forparticipants to discuss strengths and areas for improvement while their thoughts are still fresh inminds. Hot washes should be led by a facilitator and occur immediately following an exercise.Debriefings allow team members to express their thoughts about the exercise, discuss any issuesor concerns, and propose improvements for the next exercise. They should occur within a weekfollowing the exercise.LogisticsHSEEP guidance notes that logistical considerations are often overlooked, despite theirimportance for conducting a successful exercise. HSEEP recommends considering the followinglogistical considerations for a discussion-based exercise, including an exercise series and TTX. Venue (e.g., facility and room, audio/visual equipment, supplies). Badging and identification (e.g., registration, table/breakout identification). Parking, transportation, and designated areas (e.g., observer/media area).In addition, exercise setup is an important part of conducting a successful exercise. HSEEPrecommends visiting the exercise site at least 1 day prior to the event, testing audio/visualequipment, and discussing administrative and logistical issues prior to the day of the exercise.Chapter 2 – Exercise Design, Conduct, and Evaluation7

Exercise Guide for Ebola ConOps PlanningVirtual Exercise ConsiderationsJurisdictions can use video and teleconferencing as a medium for conducting exercisessimulating an Ebola-focused ConOps scenario. Virtual exercises allow connected participantsaccess to training materials, such as plans and procedures, PowerPoint presentations, anddiscussions. Participants have the ability to learn from other participants facing similar situations.In addition, virtual meetings have several logistical advantages for planners including mitigatingspace concerns, being more cost and resource effective, reducing travel requirements andplanning, and increasing opportunity to engage participants who would not otherwise be able toparticipate.However, virtual exercises do require special considerations pertaining to set-up and logistics. Ata minimum for an exercise series, teleconferencing capabilities are required for each virtualdiscussion exercise. Jurisdiction planners will need to determine the best software to use for eachmeeting based on resources, needs, and partner capabilities. Some common conferencingsoftware includes, but is not limited to, GoToMeeting , GoToWebinar , Microsoft Lync ,and VIA3 .Video-Teleconference (VTC)6 technology is ideal for a virtual TTX. VTC technology permitsusers at two or more different locations to interact with each other through a virtual face-to-faceenvironment. VTC is capable of transmitting bi-directional audio, video, and data in real time.VTC requires more in-depth logistical preparations than the more common conferencingtechnology mentioned above.2.3. Exercise EvaluationEvaluation StepsEvaluating an exercise series or TTX streamlines jurisdictional approaches for collectingexercise data through observation, collection, and analysis of data. Evaluation is used to: Assess capabilities and elements. Standardize and assess preparedness processes. Determine if exercise goals and objectives were met. Support development of an evaluation report, such as a corrective action plan (CAP).76For more information about VTC, refer to National Security Agency Video Teleconferencing, available athttps://www.nsa.gov/ia/ files/factsheets/video teleconferencing.pdf.7A CAP worksheet is provided in Appendix K and a CAP template is provided in Appendix L.Chapter 2 – Exercise Design, Conduct, and Evaluation8

Exercise Guide for Ebola ConOps PlanningExercise planners should determine the number and type of evaluation team staff based onexercise requirements and scope. Upon conclusion of an exercise, HSEEP guidance recommendsthe evaluation team compile their observations and determine actions that should occur after theexercise. Although not required for a discussion-based exercise, an after-action report (AAR) canbe used to determine areas for improvement or areas that require further action.The five key steps to evaluating an exercise are shown in the figure below. Questions to considerfor each step of the evaluation process are outlined in Appendix H.Figure 1. Evaluation zeLessonsIdenfity AreasforLearnedImprovementLessons Learned and Corrective ActionsCapturing key issues and lessons learned originating from discussion-based exercises providesopportunities for planners and participants to debrief, document, and recommend improvementsfor a future discussion exercises or TTXs. Lessons learned also may include best practices,exemplary, peer-validated techniques, procedures, good ideas, or solutions that work and aresolidly grounded in actual operations, training, and exercise experience.8 Key exercise eventsthat should be recorded as part of an evaluation are:8 Event initiation. Key decisions. Times actions occurred or were observed.From HSEEP AAR-IP Template.Chapter 2 – Exercise Design, Conduct, and Evaluation9

Exercise Guide for Ebola ConOps Planning Incoming or outgoing messages. Activities Definable and observable actions Player actions Scenario deviations Movement of personnel/equipment/resources Injects necessary to move exercise play forward Strengths Areas for improvement Best practicesCAPs assist planners in developing actions related to personnel, organization and leadership,training, planning, equipment, exercises, and evaluations. Corrective actions must be written toinclude attainable benchmarks that gauge progress toward full implementation.Participating entities should use the following questions as a guide for developing correctiveactions. What changes need to be made to plans and procedures to improve performance? What changes need to be made to organizational structures to improve performance? What changes need to be made to leadership and management processes to improveperformance? What training is needed to improve performance? What changes to (or additional) equipment is needed to improve performance? What lessons can be learned that will direct how to approach a similar problemdifferently in the future?Capturing this information in an evaluation report, such as an AAR, will enable planners toupdate existing Ebola ConOps plans, implement necessary changes, and brief officials, partners,and other participants based on results, documentation, and observations.Chapter 2 – Exercise Design, Conduct, and Evaluation10

Exercise Guide for Ebola ConOps PlanningReports and Improvement PlanningCapturing and documenting notes and observations during an exercise provides an opportunity toincrease agency capacity and capability. Corrective actions and lessons learned are key elementsto incorporate when developing an evaluation report. Incorporating these elements improves thedesign, development, and conduct of future exercise series and TTXs, improves the quality ofplans and procedures, and sustains response efforts for future exercises or emergency responseefforts.Steps for incorporating corrective actions and lessons learned into improvement plans are:1. Develop the appropriate evaluation process.2. Observe and collect exercise data.3. Analyze the data.4. Develop an evaluation report and plan to include lessons learned, corrective actions, andrecommendations.5. Meet with participants to discuss and address the lessons learned and plans forimprovement.6. Implement the corrective action plan.7. Track implementation of corrective actions and recommendations.Ultimately, the outcome of an exercise evaluation is a document that identifies gaps, lessonslearned, and corrective actions for the Ebola ConOps plan. Documentation should identifyresponsible agencies and a timeline to complete the actions and improvements.Chapter 2 – Exercise Design, Conduct, and Evaluation11

Exercise Guide for Ebola ConOps PlanningTimelineFor a less complex exercise with minimal documentation requirements, such as a discussionbased exercise, the planning timeline provided below may be useful for jurisdictional planners.9ActivityTimelineKick-off Meeting3 to 6 months before the exerciseInitial Planning Meeting (IPM)4 to 6 weeks before the exerciseFinal Planning Meeting (FPM)2 to 3 weeks before the exerciseConduct exerciseN/AHot wash with participantsImmediately following the exerciseDebrief with facilitators, evaluators, andexercise planning teamWithin a week after the exercise followingthe exerciseCorrective Action Planning Meeting2 to 3 weeks after the exerciseInterim corrective action status check4 to 6 weeks after the exerciseInterim corrective action status check3 to 6 months after the exerciseIn addition, an example timeline based on HSEEP guidance for exercise planning can be foundin Appendix F.9Adapted from the Homeland Security Protection and Resilience Toolkit,https://emilms.fema.gov/is921/921 toolkit/downloads/nppd ep.pdf.Chapter 2 – Exercise Design, Conduct, and Evaluation12

Exercise Guide for Ebola ConOps PlanningChapter 3 - Overview of Exercises in this PublicationDiscussion-based exercises are an effective approach for participating in exercises that meetcooperative agreement requirements. These exercises address strategic, policy-oriented issueswhereas operations-based exercises address actual reaction to an exercise scenario. Theseexercises also require less time and resources to design, conduct, and evaluate because they donot involve the deployment of physical resources, and they are generally less complicated thanoperations-based exercises.10 11 The value of a discussion-based exercise comes from bringingmultiple agencies and jurisdictions together to improve coordination, train staff and agencies,identify jurisdictional roles and responsibilities, improve performance, and evaluate responseactions and activities. Planners can use lessons learned from discussion-based exercises to updateEbola ConOps plans, inform training, and provide a foundation for more complex operationsbased exercises.3.1. Ebola Discussion-Based Exercise OverviewThis guide provides considerations for developing smaller, discussion-based exercises and TTXsto test an Ebola ConOps plan.12 The difference between the two is that: Smaller, discussion-based exercises cover a key element or scenario in the Ebola ConOpsplan. They are designed to acquaint participants with each other's roles andresponsibilities and to review plans and procedures. TTXs include multiple elements of the Ebola ConOps plan and involve a larger group ofparticipants13.Each exercise in this guide is designed to accomplish the following: Define clear goals and objectives for addressing each key system element as described inthe Ebola ConOps Plan Template. Determine how sectors in the jurisdiction(s) interact and respond to the chosen scenariofor the key system element(s).10IS-120a – An Introduction to Exercises, Federal Emergency Management m.11IS-130 – Exercise Evaluation and Improvement Planning, Federal Emergency Management .aspx?code IS-130.12According to HSEEP guidelines, discussion-based exercises include seminars, workshops, TTXs, and games.13For more information on key elements, refer to the Ebola ConOps Planning Template.Chapter 3 – Overview of Exercises in this Publication13

Exercise Guide for Ebola ConOps Planning Provide a platform for the collection of observations and processes used to meet goalsand objectives.This guide is set up as a two-part exercise program that includes a series of smaller exercises andTTXs. When determining what type of exercise to conduct, a planner should consider thefollowing: CDC's PHEP cooperative agreement requires a TTX or functional exercise. Conducting a TTX meets multiple cooperative agreement requirements in a singleexercise. A TTX may require more resources, ac

Exercise Guide for Ebola ConOps Planning Chapter 1 – Introduction 2 Chapter 4 provides six exercise modules, including a series of four discussion-based exercises and two tabletop exercises (TTXs). Appendices provide examples of exercise templates, worksheets, as well as a listing of acronyms and definitions. The modules in the first part

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