HLTH 6771 Week 7 Exercise Follow-Through Critique Example

Rehearsed but Not Repaired: An Exercise Critique Following Corrective Actions From a Stadium Mass-Casualty Exercise

Student Name

Walden University

HLTH 6771: Terrorism: A Systematic Approach for Emergency Preparedness

Instructor Name

Month Day, Year

Rehearsed but Not Repaired: An Exercise Critique Following Corrective Actions From a Stadium Mass-Casualty Exercise

The Exercise and the Question

Two years ago, the course's composite metropolitan county held a full-scale exercise simulating a coordinated attack during a stadium event, involving law enforcement, fire and emergency medical services, five hospitals, the emergency operations center and the public information office. The after-action report and improvement plan identified 14 findings and assigned 9 corrective actions. This critique does not judge how participants performed on the day. It asks whether the problems the exercise identified became corrective actions with owners and dates, and whether those actions were completed, by following the trail through the published after-action material and later county records.

The Standard

National exercise guidance treats improvement planning as the purpose of evaluation: findings should become corrective actions that are specific, assigned to an organization, given a completion date and tracked until complete (Federal Emergency Management Agency, 2020). An exercise that identifies problems without that follow-through rehearses the response without improving it. That standard is the measure used here.

From Findings to Corrective Actions

Of the 14 findings, 9 became corrective actions in the improvement plan. The 5 that did not were mostly observations about individual exercise play, such as a radio channel used incorrectly, which the report noted for training. Two of the five, however, were substantive: the lack of a written process for distributing patients among hospitals and the absence of a family reunification site. Neither became a corrective action, and neither appears in any later county document. The first link in the trail thinned at exactly the findings that required agreements among organizations rather than action by one. Leaving them out of the plan meant no one was ever asked to fix them.

From Actions to Owners and Dates

All 9 corrective actions named an owning organization, and 8 had a completion date. One, revising the public information plan for long events, was assigned to the emergency management office without a date. On paper, then, the improvement plan largely met the guidance's requirements for assignment. The trouble lay in what happened after the plan was filed, which is where many improvement plans quietly fail.

From Owners to Completion

Eighteen months after the exercise, county records show 4 of the 9 actions complete, 3 in progress past their due dates and 2 not started. Table 1 summarizes them.

Table 1

Corrective Action Status 18 Months After the Exercise (Composite County)

Reading the Pattern

The completed actions share two features, and both are telling: each belonged to a single organization, and each was concrete and inexpensive, a channel, a training session, a set of locations, a staffing plan. The incomplete actions tended to require coordination across organizations, sustained staff time or money that was not budgeted. The action with no date was never started, which suggests that a date is not a formality but a commitment someone can be held to. Research on the Boston Marathon bombing response credited prior drills and planning among hospitals and emergency services with the response's effectiveness (Biddinger et al., 2013), which underlines what is lost when exercise findings involving coordination among those same partners are not carried through.

What Was Rehearsed and Not Repaired

The exercise rehearsed a mass-casualty response and identified problems in patient distribution, family reunification, public information, supplies and resource tracking. Two years later, the county has fixed the problems that were easy to fix and left most of those that required coordination or money. A real incident at the stadium tomorrow would meet several of the same gaps the exercise found. In that sense, the exercise rehearsed the response but did not repair it. The money and staff time spent on the exercise bought a list of known problems, and the county has so far collected only part of the return on that investment.

Why Coordination Actions Stall

Actions that need several organizations stall for predictable reasons. No single owner can complete them, so the owner named in the improvement plan must persuade partners who have their own priorities. They often need agreements that require legal review and board approval, which take months. And they compete with daily operations for the time of the same staff who would carry them out. The hospital bed-reporting procedure is a clear example: the coalition owns it, but each of five hospitals must agree to report in the same format, and each has its own information systems and legal counsel. Without someone with authority to set a deadline, the procedure drifts.

That pattern suggests the problem is not effort or goodwill but structure. Improvement plans that assign coordination actions to a single organization without giving it authority or resources set those actions up to stall.

Recommendations

Three changes would strengthen the county's improvement planning. Every substantive finding should become a corrective action, including those that require agreements among organizations; leaving them out guarantees they will not be addressed. Every action should have a date and a budget line or a stated source of funds. And the emergency management office should report corrective action status to the county board every six months, so that actions past due become visible to the people who can fund them. The incident management system already expects coordination among these partners (Federal Emergency Management Agency, 2017); improvement planning is how that expectation becomes practice.

References

Biddinger, P. D., Baggish, A., Harrington, L., d'Hemecourt, P., Hooley, J., Jones, J., Kue, R., Troyanos, C., & Dyer, K. S. (2013). Be prepared: The Boston Marathon and mass-casualty events. New England Journal of Medicine, 368(21), 1958-1960. https://doi.org/10.1056/NEJMp1305480

Federal Emergency Management Agency. (2017). National Incident Management System (3rd ed.).

Federal Emergency Management Agency. (2020). Homeland Security Exercise and Evaluation Program (HSEEP).