Exercise Development Guide

Tabletop Exercise

Active Shooter

Exercise Development Guide Page 1

 GLOSSARY

Exercise
An activity designed to: promote emergency preparedness; test or evaluate emergency
operations, policies, plans, procedures or facilities, train personnel in emergency duties,
and demonstrate operational capabilities.

Drill
Supervised activities that test, develop, or maintain skills in a single response procedure
(such as: communications, notification, lockdown, fire). Helps prepare for more complex
exercises in which several functions are coordinated and tested.

Tabletop Exercise
Simulates an emergency situation in an informal, stress-free environment. Designed to
elicit discussion as participants examine and resolve problems based on existing crisis
management plans.

Functional Exercise
A fully simulated interactive exercise; tests one or more functions in a time-pressured
realistic simulation; focuses on policies, procedures, roles, and responsibilities.

Full-Scale Exercise
Evaluates the operational capability of emergency response management systems in an
interactive manner. Includes the mobilization of emergency personnel and resources
required to demonstrate coordination and response capability. Tests total response
capability as close to a real emergency as possible.

Statement of Purpose
Defines the reason why an exercise needs to be conducted. Includes the functions to be
tested, the personnel and agencies involved, and the type of threat to be simulated.

Objective
A goal expressed in simple, clear, specific, and measurable terms. Serves as the foundation
of all exercise planning.

Scenario
The overall outline of how an exercise will be conducted. Includes the narrative,
major/detailed sequence of events, problems or messages, and expected actions.

Exercise Development Guide Page 2

 EXERCISE DEVELOPMENT WORKSHEET

1. What of your highest priority natural, technological, or man-made hazards or threats

to your center would you like to test?
Active Shooter

2. What emergency management functions are most in need of rehearsal?

Communications Fire Drills
Weather Drills Resource Management
Evacuation/Shelter-in-place x Violence Management
x Injury Assistance x Lockdown/Controlled Access
Utilities – power, water, hvac, medical gas, fuel, etc-list:
Test new procedure/equipment (identify)-
x External Agency Interaction – Law Enforcement
Other (identify)

3. Which type of exercise do you intend to conduct?

Drill
x Tabletop Exercise
Functional Exercise
Full-Scale Exercise

4. Define the scope of the exercise

Geographic Free-standing ASC or location within a medical office building
Location If more than one location, list specific location.
Date/Time of List date of exercise
Exercise Actual start time of exercise – could be different from simulated
time of exercise e.g., you may have the tabletop exercise start at
2 p.m., however the exercise simulation time may be 8 a.m. so
that it is when you have more patients present.
Duration of Duration of the actual tabletop exercise may only be 1 hour,
Exercise however the simulated duration of the exercise may cover
several hours.
Participants All available staff
At a minimum: Administrator, Team Leaders

5. Determine the purpose of the exercise.

The purpose of the exercise is to test and evaluate the emergency functions of activating
the emergency operations plan to respond to an infrastructure issue by involving
administration, team leaders in a tabletop exercise simulating an active shooter situation
at the center.

Exercise Development Guide Page 3

6. Develop the overall goal and objectives for the exercise
Goal: Identify functionality of written emergency plan and identify gaps in plan and
further training opportunities.

Objectives:
a. Evaluate the communication process between the administration and staff,
with patients/families, and with external organizations
b. Evaluate the staff response to an active shooter situation
c. Evaluate the process for working with local law enforcement

7. Write the exercise narrative: scenario and events to take place over the course of the
exercise.
SCENARIO

A 40 year-old man enters your lobby area with a handgun and demands to see his
wife (who is one of your employees). When the front desk person attempts to
calm him down, he shoots her (life threatening wound). Only one person is in the
lobby area waiting for their family member and is for the most part un-noticed.
Another employee hears the noise and walks toward the lobby to investigate. The
shooter fires at this approaching employee, but the employee dives for cover and
the shooter misses. The shooter continues into the enter sanctum of the center,
while the employee who dove for cover calls 911, as has the visitor in the lobby.
As the shooter progresses through the center, he shoots 2 other staff (not life
threatening wounds) while searching for his wife. The police tactical team arrives
in 6 minutes. And finds the shooter dead of a self-inflicted gun-shot wound.
Once the police have secured the scene, the EMS are allowed to come in to
intervene and transport the wounded. The areas where the shooter has been are
shut down as crime scenes and the police begin their interviews and collection of
evidence. Media arrive on the scene approximately 20 minutes after the incident
began.

Messages/Questions – these questions are pertinent regardless of the type of

utility system that fails.
a. Do you activate Incident Command and your Emergency Operations
Plan?
b. How are staff and patients notified regarding the developing situation?
c. What community response agencies and healthcare partners do you notify
regarding your situation?
d. Is your staff knowledgeable in how to react to this situation as related to a
“run, hide, fight” response?
e. Do you have clearly marked exit and escape routes?

Exercise Development Guide Page 4

 f. Have you identified safe rooms for the staff?
g. Do you have rooms with locks? Are bathrooms capable of being locked?
Can a patient care area be secured?
h. Has your staff had training on aggressive behavior management?
i. Do you have a panic alarm at strategic locations? Are these routinely
tested?
j. Does your center have a process for staff to alert administration of any
restraining orders or other restrictive court orders?
k. Do you have procedures that address the automatic opening of card
access doors to aid in law enforcement response, escaping hostages, and
the deactivation of card readers to isolate the threat?
l. Do you have a plan for providing behavioral health support and
debriefing services to the incident victims and staff?
m. Do you have a plan on how to manage the media in this situation?
n. Do you have a plan for reporting and documenting staff injuries?
o. Do you have a policy and procedure to address line-of-duty death?
p. What factors are considered regarding whether non-closed areas can
remain open? (This may depend on the situation regarding law
enforcement crime scene investigation over which you will have no
control.)

8. Develop exercise documents and plan for post exercise activities

 Exercise Briefing Report – See addendum A
 Exercise Evaluation Guide / Incident Critique – See addendum B
 Conduct Exercise Hotwash – See addendum C
 Complete After Action Report/Improvement Plan – See addendum D

Exercise Development Guide Page 5

Addendum A
Exercise Briefing Report

We will be conducting a tabletop exercise to test our ability to activate and follow our
emergency operations plan in response to a (insert specific event type). The exercise
objectives are as follows:
1. Insert specific objectives for this exercise

This exercise will be held in an open, low-stress, no-fault environment. Varying viewpoints,
even disagreements, are expected.
Respond to the scenario using your knowledge of current plans and capabilities (i.e., you
may use only existing assets) and insights derived from your training.
Decisions are not precedent setting and may not reflect our organization’s final position on a
given issue. This exercise is an opportunity to discuss and present multiple options and
possible solutions.
Issue identification is not as valuable as suggestions and recommended actions that could
improve protection, response, and recovery efforts. Problem-solving efforts should be the
focus.
Following the exercise, we will conduct a debriefing (hotwash) to critique the exercise. A
written After Action Report will be developed along with any corrective action plan.

Exercise Development Guide Page 6

Addendum B
Exercise Critique

Exercise Critique Form

Emergency Plan o Tested or o Activated:
Date: ___/___/_____ Time: __________
Evaluator(s):___________________________
Brief description of drill/exercise scenario or actual event:

Tabletop Exercise – Active Shooter

Summary Results of exercise/drill or event:

Assessment of Incident Management and Critical Areas of Response to Emergencies during

Actual Events or Exercise/Drills

Incident Command
Was the Emergency Plan activated? ___________________________________________

Was an Incident Commander notified? _____

Was an Incident Management Team put in place? _____

Was the location of the command center appropriate and had necessary supplies, tools,
and equipment? ___ If no, was problems were identified?

________________________________________________________________________

Was coordination with outside agency command post effective?

_______________________________________________________________________

Communication
How much time did it take to notify staff of the emergency/activation?
_________________________________________________________________________

Was Administrator notified: Yes_____ No ______ Time: ____________

How did your communication systems function? Were there any problems; if yes, what
were they?
__________________________________________________________________________

Did you have redundant methods of Communication: __ Telephone __ Pager __ Cell Phone

Exercise Development Guide Page 7

__ Radio __ Other:_________

Does your plan describe how to communicate with staff, patients, and other healthcare
partners during an emergency?

__________________________________________________________________________

Resources
Did the plan anticipate all key needs, such as space, communication equipment, staff, and
supplies?
__________________________________________________________________________

Was the center’s ability to function compromised? _______. If yes, please explain:
__________________________________________________________________________

Is your back-up plans for supplies adequate? _____________________________________

Do you have plans that adequately support the needs for securing the building and
contents during a temporary closure of the center?

__________________________________________________________________________

Safety & Security

Was anyone within the facility injured? _______. If yes, please explain:
__________________________________________________________________________

Was your plan for managing an injured staff person, patient, or visitor sufficient during
emergency situations? _______________________________________________________

Did the center require security or police activation? _______. If yes, please explain:
__________________________________________________________________________

Staff Responsibility
Did staff go where they were supposed to and what to do?
_________________________________________________________________________

Were any extra needs of the staff identified, e.g., rest breaks, hydration/nourishment,
emotional support, family support, etc.
__________________________________________________________________________

Utilities
Did the center have any disruptions in service? _______ If yes, did you know who to contact?
_________________________________________________________________________________

Were appropriate “work-around” processes identified in the plan?

_________________________________________________________________________________

Were the alternative processes effective?

_________________________________________________________________________________

Exercise Development Guide Page 8

Patient Clinical & Support Activities
If necessary, did the plan describe how to manage on-site victims?
__________________________________________________________________________

Does your plan adequately explain the process for temporary curtailment of procedures?

__________________________________________________________________________

If needed, was there adequate/appropriate Personal Protective Equipment on site for

staff?
__________________________________________________________________________
If closed, does your plan include a process for an alternate care site and methodology to continue
your services in another location? _____________________________________________________

Evaluation (circle
Exercise Objectives Needed Change
one)
a. Evaluate the communication
process between the Met
administration and staff, with Some challenges
patients/families, and with Major challenges
external organizations Not met

b. Evaluate the staff response to Met

an active shooter situation Some challenges
Major challenges
Not met
c. Evaluate the process for Met
working with local law Some challenges
enforcement Major challenges
Not met

Signature of Preparer: ____________________________________________

Exercise Development Guide Page 9

Addendum C
Hotwash Worksheet Template

Hot Wash Session Worksheet

As you conduct your debriefing, please complete this worksheet.

STRENGTHS — Indicate what your center/department did well during the

exercise/event considering these areas.
1. Communication

2. Resources and Assets

3. Safety and Security

4. Staff

5. Utilities

6. Patient Care and Support Activities

7. Other things that went well

Exercise Development Guide Page 10

AREAS FOR IMPROVEMENT — Indicate areas and/or processes that need
improvement at your center/department based on the outcome of the
exercise/event in the following areas.
1. Communication

2. Resources and Assets

3. Safety and Security

4. Staff

5. Utilities

6. Patient Care and Support Activities

7. Other things that went wrong

Indicate any lessons you learned or best practices you did that should be
shared.

Exercise Development Guide Page 11

Addendum D
After Action Report

After Action Report for Exercises

Center Name/Location __________________________________________________________________

Exercise Date & Time Period _____________________________________________________________

Purpose of Exercise
Detail whether this was a center-initiated exercise or one that was initiated by community, county, or regional agencies
(be specific). State why the exercise was conducted, including which target capabilities (critical areas) and activities were
defined as needing to be exercised. OR describe event that impacted the center.

Planning Team
If community, county, or regional drill, list agencies that were involved; if planning occurred through the center, list team
members or committee name.

Participating Agencies
List all agencies that participated in the exercise. Include number of participants from within the center.

Scenario Overview
 After Action Report
Objectives

1. ____________________________________________________________________________________
2. ____________________________________________________________________________________
3. ____________________________________________________________________________________

Observed Strengths

 ____________________________________________________________________________________
 ____________________________________________________________________________________
 ____________________________________________________________________________________
 ____________________________________________________________________________________
 ____________________________________________________________________________________
 ____________________________________________________________________________________
 ____________________________________________________________________________________
 ____________________________________________________________________________________

Priority Areas for Improvement

1. Communication
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

2. Resources
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

3. Safety and Security

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

4. Staffing
 After Action Report
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

5. Utilities and Facilities

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

6. Clinical and Support Activities

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Conclusion and Summary

Include key lessons learned and best practices.

 After Action Report

Appendix A: Improvement Plan

This Improvement Plan has been developed specifically for _________________________________________ as a result of the exercise on
____________. These recommendations draw on both the After Action Report and the After Action Review.

Primary
Anticipated
Capability / Responsible Start
Observed Problem Recommendation Corrective Action Description Completion
Critical Area Department/Perso Date
Date
n
Communications

Resource
Mobilization
and Allocation

Safety and Security

Staffing

Utilities and Facilities

Clinical and Support

Activities