LOS ANGELES COUNTY

2026 ANNUAL MEDICAL & HEALTH EXERCISE (AMHE) PARTICIPANT WEBINAR

EXERCISE PLANNING 101

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Essence Wilson, Senior Nursing Instructor

Disaster Program Manager

eswilson@dhs.lacounty.gov

562-378-2442

PRESENTATION OBJECTIVES

At the end of this presentation, each participant will be able to:

• Define 3 types of exercise – tabletop, functional and full-scale
• Verbalize at least 3 components needed to plan/conduct an exercise
• Understand the purpose of each component and how they relate to each other
• Discuss how to adapt the LA County Master Scenario Events List (MSEL) to suit the needs of their facility or agency

EMS AGENCY

• Support agency – responsible for coordinating care during a large-scale disaster or incident either within the Medical Alert Center (MAC) or Medical Coordination Center (MCC)
• Not affiliated with CMS nor any other regulatory body, however, exercising with us may assist sectors in meeting some regulatory requirements
• Mission is to support and train medical sectors to be prepared for a disaster

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Overarching goal during a disaster: Each patient receive the correct care at the correct facility that can meet their needs

DEFINITIONS OF 3 TYPES OF EXERCISES

• Tabletop exercise (TTX)

• Functional exercise

• Full-scale exercise

• Facilitator guided discussion on one or more scenarios. Focus on policies and procedures

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• Simulated operational environment. Designed to exercise specific team members, processes and/or resources
• Typically, a lengthier exercise that takes place on location using equipment and personnel that would be called upon in an actual event (most realistic)

• Community Wide - An exercise that involves more that just your facility or agency

EXERCISE COMPONENTS

• Objectives
• Scenario
• Master Scenario Events List (MSEL)
• Exercise Injects (i.e. victims, messages)
• Exercise Evaluation/Participant Feedback
• After Action Report (AAR)
• Improvement Plan (IP)

2026 AMHE

OBJECTIVES

• Objectives are what you would like to test e.g., communication, triage, contacting specialists, etc.
• Review previous AARs and IPs
• For each objective, list steps on how the objective could be tested – example to follow
• Need to be measurable

OBJECTIVE EXAMPLE

OBJECTIVE: Communication

• Maintain situational awareness by gathering and sharing real-time information related to the emergency and the current state of the (facility/agency) through coordination with ….(staff, EMS Agency, etc.)

Sample Task(s):

• Activate communication plan/policy or develop a process for sharing of information related to the incident with on-duty staff and those who are scheduled to work within 30 minutes of incident notification
• Respond to communication received from local healthcare partners and/or EMS Agency MCC, e.g., service level request, resource availability and/or capabilities.
• Utilize and test redundant communication systems [insert specific systems to test, such as text messaging, email, mass notification software, etc. – refer to your communication plan/policy] to notify staff, response partners and EMS Agency MCC as applicable.

SCENARIO

• The scenario should be developed after the objectives have been determined so that it can test the objectives
• However, with the Annual Medical and Health Exercise (AMHE), the scenario has already been set – Critical Infrastructure: Targeted Violence and Power Outage.
• Scenario should be relevant, and include situations that will test the objectives i.e., based on your Hazard Vulnerability Analysis/Assessment (HVA)

MASTER SCENARIO EVENTS LIST (MSEL)

• Chronological listing of events
• Used in an exercise
• Based on the scenario and sample tasks for each objective
• Each row is called an inject with a time assigned to it
• Column headings may include, but not limited to inject number, time, from and to actual message/information, expected action, … etc.
• MSEL for the AMHE has more columns
• Only exercise controllers should have access to the MSEL

EXCERPT FROM AMHE MSEL

EXERCISE INJECTS

• Hand delivered message
• Email blast
• Phone call
• Overhead announcement
• Mass notification message
• Pre-filled forms (i.e., FAC seeker forms)
• Live mock victims

INJECT IDEAS FOR LOSS OF POWER

• Lighting
• Loss of VOIP phones
• Hand-off communication
• Operating Room coordination
• CT scan did not come back on and requires vendor to reboot it
• Impact to Trauma or Stroke center designation
• Loss of Central monitor at Nursing Station
• Badge access doors
• Loss of Pyxis
• Blood Bank staff report loss of refrigerator storing blood products
• Reports of environmental temperature increase, you discover the HVAC system has not come back online
• Elevator outage with a critical patient stuck inside
• Vaccine refrigerator did not come back on
• Loss of dietary refrigerator

EXERCISE EVALUATION – PARTICIPANT FEEDBACK FORM

• Exercise evaluation guides are available on the LACountyHCC.org website along with a Participant Feedback Form
• Anyone who participates in any way (player, controller, evaluator, etc.) should complete a feedback form

• Information from evals and feedback should be collated, organized and put into an After-Action Report (AAR)

AFTER ACTION REPORT (AAR)

/IMPROVEMENT PLAN (IP)

• Can be two documents or combined into one
• AAR contains information on how the exercise went – did you meet your objectives by completing the sample tasks?
• Which areas did you do well in (strengths)
• Which areas need some improvement
• Improvement plan should be based on the areas for improvement
• AARs for the are due 60 days after the exercise (mid January 2027)

AFTER ACTION REPORT (CONTD.)

List top 3 strengths

• We were able to contact all staff both in the facility and those scheduled to work later in the day

List top 3 areas for improvement

• We were unable to contact all appropriate staff as the call list did not contain everyone’s current numbers

IMPROVEMENT PLAN

• Improvement plan is based on your areas for improvement
• Based on the previous example - We were unable to contact all appropriate staff as the call list did not contain everyone’s current numbers
• Enter the date to be accomplished and the person responsible for completing the task

EMS AGENCY DISASTER PROGRAM MANAGERS

Hospitals, Pediatric Surge, Trauma Surge, Burn Surge, HDMT:

• Essence Wilson
• Email: eswilson@dhs.lacounty.gov
• Phone: 562-378-2442

Clinics, Long Term Care Facilities, EMS Providers, Emerging Infectious Diseases:

• Nnabuike “BK” Nwanonenyi
• Email: nwanon@dhs.lacounty.gov
• Phone: 562-378-2460

Ambulatory Surgery Centers, Dialysis Centers, Home Health/Hospice Agencies, Urgent Cares:

• Lorna Mendoza
• Email: lmendoza3@dhs.lacounty.gov
• Phone: 562-378-2457

REFERENCES

Homeland Security Exercise and Evaluation Program (HSEEP) https://www.fema.gov/sites/default/files/2020-04/Homeland-Security-Exercise-and-Evaluation-Program-Doctrine-2020-Revision-2-2-25.pdf

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Exercises. (2023). Ready. https://www.ready.gov/business/training/testing-exercise/exercises

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Resource Links

Lacountyhcc.org

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https://dhs.lacounty.gov/emergency-medical-services-agency/home/disaster-programs/

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THANK YOU