AFTER ACTION REPORT/IMPROVEMENT PLAN...2010/01/07 · Homeland Security Exercise and Evaluation...
Transcript of AFTER ACTION REPORT/IMPROVEMENT PLAN...2010/01/07 · Homeland Security Exercise and Evaluation...
Health Survey 2010
October 23, 2010
AFTER ACTION
REPORT/IMPROVEMENT PLAN Publication Date: January 2011
Greater Nashua Public Health Region
City of Nashua, Division of Public Health &
Community Services
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Administrative Handling Instructions
1. The title of this document is Health Survey 2010 After Action Report and
Improvement Plan
2. The information gathered in this AAR/IP is classified as [For Official Use Only
(FOUO)] and should be handled as sensitive information not to be disclosed. This
document should be safeguarded, handled, transmitted, and stored in accordance
with appropriate security directives. Reproduction of this document, in whole or
in part, without prior approval from the City of Nashua, Division of Public Health
& Community Services is prohibited.
3. Points of Contact:
Ashley Conley, MS, CPH
Epidemiologist
City of Nashua, Division of Public Health & Community Services
18 Mulberry Street
Nashua, NH 03060
603-589-4552 (office)
Patty Crooker, MPH
Regional Public Health Preparedness Coordinator
City of Nashua, Division of Public Health & Community Services
18 Mulberry Street
Nashua, NH 03060
603-589-4507 (office)
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Table of Contents
Administrative Handling Instructions ................................................................................. 2
Table of Contents ................................................................................................................ 3
Executive Summary ............................................................................................................ 4
Major Strengths ................................................................................................................... 4
Primary Areas for Improvement ......................................................................................... 4
Section 1: Exercise Overview ............................................................................................. 5
Exercise Details .............................................................................................................. 5
Exercise Planning Team Leadership ............................................................................... 6
Participating Organizations ................................................................................................. 7
Section 2: Exercise Design Summary ................................................................................. 7
Exercise Purpose and Design .......................................................................................... 7
Exercise Objectives, Capabilities, and Activities ............................................................... 9
Scenario Summary .......................................................................................................... 9
Section 3: Analysis of Capabilities ..................................................................................... 9
Capability 1: Communications ..................................................................................... 10
Capability 2: EOC Management ................................................................................... 11
Capability 3: Epidemiological Surveillance and Investigation ..................................... 12
Other Strengths and Areas for Improvement: ............................................................... 13
Capability: Volunteer Management .............................................................................. 13
Capability: Planning and Preparation ........................................................................... 14
Section 4: Conclusion ....................................................................................................... 16
Appendix A: Improvement Plan ....................................................................................... 17
Appendix B: Participant Feedback Summary ................................................................... 21
Appendix C: Exercise Events Summary Table ................................................................. 28
Appendix D: Acronyms .................................................................................................... 30
Appendix E: THANK YOU TO OUR VOLUNTEERS!!! ............................................... 31
List of Tables Table 1: Health Survey 2010 10-23-10 Events Summary ................................................ 28
Table 2: Health Survey 2010 11-6-10 Events Summary .................................................. 29
Table 3: Acronyms ............................................................................................................ 30
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Executive Summary
The Greater Nashua Public Health Region and the City of Nashua Division of Public
Health & Community Services (DPH&CS) operations based functional exercise “Health
Survey 2010” was developed to test communications capability, emergency operations
center management, and epidemiological surveillance and investigation capabilities.
The exercise planning team was composed of numerous and diverse agencies, including
regional partners, public health network coordinators, organizations from the Community
Health Assessment Advisory Board, medical partners and the local colleges. The
exercise planning team discussed the logistics regarding the content and length of the
health survey, qualifications for participation as volunteer, avenues to publicize the event
to diverse communities, and the operational support needed at the command post to
ensure the safety and efficiency of the event. Based on the exercise planning team’s
deliberations, the following objectives were developed for Health Survey 2010:
Objective 1: To test our communications plan using landlines, cell phones, walkie
talkies and radios.
Objective 2: To coordinate the health survey, allocate resources, provide support
and maintain communication with our volunteers.
Objective 3: To gather health data from 210 residents using the Center for Disease
Control’s Community Assessment for Public Health Emergency Response
(CASPER) protocol and Capturx digital pens and paper.
The purpose of this report is to analyze the results from the exercise, identify strengths to
be maintained and built upon, identify potential areas for further improvement, and
support development of corrective actions.
Major Strengths The major strengths identified during this exercise are as follows:
Issues that arose for survey teams were handled quickly and efficiently.
Bilingual survey teams were available throughout the day.
Pre-event the media campaign helped to notify residents of the health survey.
Primary Areas for Improvement Throughout the exercise, several opportunities for improvement in the Greater Nashua
Region’s ability to respond to the incident were identified. The primary areas for
improvement, including recommendations, are as follows:
Team leaders were not able to reach the survey teams at all times. Team leaders
should enforce the importance of the communications checks to the teams. One
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individual on each team should be assigned as the communication lead and be
responsible for answering calls from the command post and/or team leaders.
Incoming calls became overwhelming when many of the survey teams were
calling in to the team leaders at the same time. Handheld radios instead of walkie
talkies should be used to enhance communications and efficiency. The command
post could also set-up a bank of phones with support staff for the teams to call
while in the field.
Support staffs that are sent into the field to deliver lunches, equipment, etc should
be in teams of two to ensure safety and increase efficiency.
Overall, the exercise was a success and the Region was able to implement the CDC’s
CASPER protocol. The teams reached their starting points promptly, equipped with all
the materials and resources needed to navigate Nashua’s neighborhoods in a safe manner.
They interacted cordially with residents to complete the surveys, communicated with the
command post and team leaders. In the end, 207 of the 210 health surveys were
completed from 30 randomly selected neighborhoods in the City of Nashua.
Section 1: Exercise Overview
Exercise Details
Exercise Name: Health Survey 2010
Type of Exercise: Functional Exercise
Exercise Start Date: October 23, 2010
Exercise End Date: October 23, 2010
NOTE: Teams of volunteers also went into the community to gather additional
surveys on November 6, 2010. Evaluations and information gathered from this
event will also be added to this report even though the “official” exercise was
performed on 10/23/2010.
Duration: 1 day or 8 hours (0800hr – 1600hr)
Location: Division of Public Health and Community Services, 18 Mulberry Street,
Nashua, NH 03060 and 30 randomly selected neighborhoods in the City of Nashua
Sponsors:
New Hampshire Department of Health and Human Services,
United States Department of Health and Human Services/Centers for Disease
Control and Prevention,
City of Nashua, Division of Public Health & Community Services
St. Joseph’s Hospital,
Southern New Hampshire Medical Center,
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Nashua Area Health Center.
Capabilities: Communication, Emergency Operation Management, and Epidemiological
Surveillance and Investigation
Scenario Type: Operations-based
Exercise Planning Team Leadership
Project Coordinators:
Ashley Conley, Epidemiologist
Division of Public Health and Community Services
18 Mulberry Street, Nashua, NH 03060
603-589-4552
Patty Crooker, Regional Public Health Preparedness Coordinator
Division of Public Health and Community Services
18 Mulberry Street, Nashua, NH 03060
603-589-4507
Community Health Assessment Health Survey Committee
Victoria Alabi, Public Health Associate
DPH&CS
Primary Author
Mike Amichetti, Case Technician
DPH&CS
Theresa Calope, Public Health Nurse
DPH&CS
Amy Cullum, Senior Consultant
Community Health Institute
Debbie Daniels, Medical Director
DPH&CS
Corinn Dembkoski, Public Health
Specialist
DPH&CS
Mariellen Durso, Director
Nashua Area Health Center
Meredith Lyons, Environmental Health
Specialist
DPH&CS
Ray Peterson, Vice President
United Way of Greater Nashua
Technical Assistance: Beatrice J. Selwyn, ScD, Associate Professor, University of Texas
School of Public Health
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Participating Organizations
City of Nashua, Assessing & GIS Department
City of Nashua, Board of Health
City of Nashua, Division of Public Health & Community Services
City of Nashua, Risk Management
City of Nashua, Police Department
Community Members
Dartmouth-Hitchcock
Gateways Community Services
Greater Derry Medical Reserve Corps
Greater Nashua Public Health Region
Greater Nashua Mental Health Center at Community Council
Hillsborough County Amateur Radio Emergency Services
Nashua Area Health Center
Nashua Community College
Nashua Police Athletic League
NH Department of Health & Human Services
NH Gateway Chapter of the American Red Cross
NH Homeland Security & Emergency Management
Parent Coach
Rivier College
Southern New Hampshire Medical Center
Southern NH Services
St. Joseph Hospital
St. Luis de Gonzague Parish
Number of Participants
October 23, 2010 November 6, 2010
Volunteers: 33 Volunteers: 26
Evaluators: 1 Evaluators: 0
Support Staff: 9 Support Staff: 5
Section 2: Exercise Design Summary
Exercise Purpose and Design
The Division of Public Health and Community Services identified the Community Health
Assessment (CHA) as a primary need in its strategic plan in 2009. The overall goal of the
CHA is to gather and analyze health data on the Nashua community and use this data to
inform and focus the Division’s health programming. The health survey was identified as
the best tool through which to gather this information directly from the community. The
coordinators of the exercise reviewed similar studies done by other health departments
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and recognized this opportunity to conduct the survey according to the CDC’s
Community Assessment for Public Health Emergency Response (CASPER) protocol.
This type of rapid needs assessment is usually performed following disasters or large-
scale emergencies. Trained in using the CASPER protocol, the coordinators organized
this exercise so that the benefits would be two-fold: collecting health data to improve the
health of the City of Nashua and practicing epidemiological investigation in emergency
situations with volunteers trained in using the protocol. The hope is that the Greater
Nashua Public Health Region can develop a protocol based on these experiences that can
be used following a disaster or large-scale emergency.
Thirty teams of volunteers would visit thirty neighborhoods in Nashua and
interview a total of 210 residents using the health survey. The neighborhoods were
randomly chosen using a cluster sampling method that was first used by the World Health
Organization for determining immunization status. A cohort of volunteers was recruited
through an application process and attended a full day training. The command post was
set up at the DPH&CS with enough team leaders and staff to support the volunteers when
out in the field.
Each team was provided with a map of their walking path that pictured the houses
to be interviewed in their assigned block group. The maps included legends which
directed teams on how to keep track of the houses surveyed, those that refused, had a
language barrier or had no one at home. The survey contained 34 questions covering a
variety of health topics that include access to care, oral health, chronic diseases,
emergency preparedness and community health. Depending on the interviewee, the
survey took approximately 10 to 35 minutes to conduct. The surveys were translated into
Spanish and Portuguese. The survey was reviewed by a focus group and the CHA Data
Subcommittee.
The teams were provided with Capturx digital pens and answer sheets to record
the answers to the survey. The pens store the answers recorded on the digital paper and
when docked to the computer, automatically downloads into an excel spreadsheet and
ArcGIS program. The pens decreased the amount of time and number of errors associated
with inputting data manually.
The overall goal was to maintain communication, provide support to the
volunteers, retrieve epidemiological data, practice the CASPER protocol and have fun
while serving the Nashua community. Funding for this exercise was generously provided
by the New Hampshire Department of Health and Human Services, United States
Department of Health and Human Services/Centers for Disease Control, City of Nashua
DPH&CS, Nashua Area Health Center, Southern New Hampshire Medical Center and St.
Joseph’s Hospital.
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Exercise Objectives, Capabilities, and Activities
Capabilities-based planning allows for exercise planning teams to develop exercise
objectives and observe exercise outcomes through a framework of specific action items
that were derived from the Target Capabilities List (TCL). The capabilities listed below
form the foundation for the organization of all objectives and observations in this
exercise. Additionally, each capability is linked to several corresponding activities and
tasks to provide additional detail.
Based upon the identified exercise objectives below, the exercise planning team has
decided to demonstrate the following capabilities during this exercise:
Objective 1: To test our communications plan using landlines, cell phones, walkie talkies
and radios.
Communications: Alert & Dispatch; Provide Emergency Operations Center
Communications Support
Objective 2: To coordinate the health survey, allocate resources and maintain
communication.
Emergency Operations Center Management: Activate EOC/MACC/IOF; Identify
and Address Issues; and Provide EOC/MACC/IOF Connectivity.
Objective 3: To gather health data from 210 residents using the CDC’s CASPER
protocol and test the use of the Capturx pens for completing the answer sheets for the
survey and mapping walking paths on maps.
Epidemiology/Surveillance: Surveillance and Detection
Scenario Summary The health survey will help the DPH&CS collect information on health topics. For the
exercise, volunteers were recruited and trained according to the CASPER protocol to go
out into the community and gather this data. They attended an all day training the day
before the survey day that reviewed the survey questions, the protocol for interviewing
houses and apartment complexes, safety precautions, maintaining cultural competency in
working with diverse residents and more. On the day of the survey, volunteers convened
at Southern New Hampshire Medical Center (11/6 – St. Joseph Hospital) and were
provided the necessary equipment needed to conduct the surveys. Throughout the day,
volunteers communicated with the team leaders and support staff stationed at the
command post. From this post, the support staff coordinated the main communications,
operations and logistical functions to ensure the efficiency of the exercise.
Section 3: Analysis of Capabilities
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This section of the report reviews the performance of the exercised capabilities, activities,
and tasks. In this section, observations are organized by capability and associated
activities. The capabilities linked to the exercise objectives of Health Survey 2010 are
listed below, followed by corresponding activities. Each activity is followed by related
observations, which include references, analysis, and recommendations.
Capability 1: Communications
Capability Summary: Communications is the fundamental capability within disciplines
and jurisdictions that practitioners need to perform the most routine and basic elements of
their job functions. Agencies must be operable, meaning they possess sufficient wireless
communications capabilities to meet their daily internal and emergency communication
requirements before they focus on interoperability. For the Health Survey 2010 exercise,
the goal was to maintain communication between the volunteers and team leaders at the
command post.
Activity 1: Provide Emergency Operations Center Communications Support
Observation 1.1: Strength and Weakness
Analysis: The survey teams were able to contact their team leader or the command post
when needed using cell phones. During the survey, two way walkie talkie
communications were tested. As teams traveled further into various parts of the City, the
walkie talkies stopped working. However, due to cell phone use the teams were able to
contact their team leaders as the need arose. Teams were never unable to get in touch
with their team leaders or the command post.
Recommendations: Instead of using walkie talkies, utilize handheld radios.
Update: When teams returned to the field on November 6, 2010, the teams used
handheld radios instead of the walkie talkies which enhanced communications between
the teams, team leaders and the command post. The handheld radios worked throughout
the entire City and were more efficient.
Observation 1.2: Area for Improvement
Analysis: Throughout the course of the day there were a few survey teams that the team
leaders were not able to reach via walkie talkie or cell phone communications. Team
leaders were conducting status checks on teams that they had not heard from in some
time and were not able to get through via walkie talkie or cell phone. Eventually, they
were able to make contact with each team, however at one point a staff member had to go
into the field to track down the survey team. The survey teams explained they had shut
the ringer off on their phone or were in the middle of a survey and did not answer.
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Recommendations: Nashua DPH&CS should reinforce to the survey teams the
importance of the communications checks. One individual on each team should be
assigned as the communication lead and be responsible for answering calls from the
MACE and/or team leads.
Update: On November 6, 2010 when the teams returned to the field with the handheld
radios, communications were more efficient and it was easier for the teams to
communicate without interrupting the interviewees as they were answering questions.
Each team also assigned one person to wear and use the handheld radio while they were
in the field.
Observation 1.3: Area for Improvement
Analysis: In the latter part of the day as teams were making progress with their surveys,
they tended to be calling in all at the same time. Phone calls became overwhelming and
were not able to be answered and went to voicemail many times. While team leads were
trying to make outgoing calls to extend survey paths they became inundated with time
check calls from other teams. While survey extensions are important for team leads to
handle, simple calls such as time checks could be completed more efficiently by support
staff.
Recommendations: MACE team should have a bank of phones for the survey teams to
call into with support staff answering the calls. Any issues or concerns should be pushed
up to the team leads. Use of handheld radios may make this process more efficient.
Update: On November 6th
, 2010, teams were required to check in only after completing
their surveys and not when they both started and completed the survey. The coordinators
also extended the walk on the maps for each team prior to deployment. This significantly
decreased the number of calls coming in at once.
Capability 2: EOC Management Capability Summary: Emergency Operations Center (EOC) management is the
capability to provide multi-agency coordination (MAC) for incident management by
activating and operating an EOC for a pre-planned or no-notice event. EOC management
includes: EOC activation, notification, staffing, and deactivation; management, direction,
control, and coordination of response and recovery activities; coordination of efforts
among neighboring governments at each level and among local, regional, and State
partners.
Activity 2: Provide EOC/MACC/IOF Connectivity
Observation 2.1: Area for Improvement
Analysis: While setting up the MACE, staff was unable to log into the computer as the
“MACE”. It was discovered that the IT Department had disabled the MACE account on
the computer.
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Recommendations: Nashua DPHS&CS should have IT support on duty or on standby
during exercises and real world events to troubleshoot and solve IT issues. It would also
be beneficial to have the MACE account established with a password/account that does
not expire.
Activity 3: Identify and Address Issues
Observation 3.2: Area for Improvement
Analysis: Support staff sent into the field should be in teams of at least two. Some
support staff went to deliver lunch to the teams by themselves. To ensure safety, the
buddy system should be used.
Recommendations: For safety and efficiency purposes the MACE staff should ensure
that all teams that are sent into the field, regardless of task, are done so in a minimum of
two person teams.
Update: On November 6th
, support staff members were not sent out into the field alone.
Observation 3.3: Strength
Analysis: Issues that arose for survey teams were handled quickly and efficiently. Teams
ran into various issues throughout the day that required immediate decision making from
team leads and the MACE staff. Calls were taken immediately and issues were resolved
rather quickly. These situations did not delay the survey process and were handled very
well.
Recommendations: Continue open communication and pre-event education to survey
partners.
Capability 3: Epidemiological Surveillance and Investigation Capability Summary: The Epidemiological Surveillance and Investigation capability is
the capacity to rapidly conduct epidemiological investigations.
Activity: Surveillance and Detection
Observation 3.1: Strength
Analysis: Survey teams were efficient and friendly while conducting the surveys. Many
teams made it through their initial loop right before or immediately following their lunch
break. While many Nashua residents were not home or unavailable, the ones who did
participate in the survey welcomed the survey teams and were comfortable with their
presence in their homes.
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Recommendations: Continue training for teams regarding personal safety, education of
the survey needs and the goal of the program.
Observation 3.2: Strength
Analysis: There were two survey teams that had bilingual individuals on the team and
they were available throughout the day. Due to Nashua’s diverse population it is
imperative that individuals who are conducting the surveys on behalf of the city are able
to communicate with the residents and gather accurate information.
Recommendations: Recruit more multilingual survey team members to assist with the
survey process.
Other Strengths and Areas for Improvement:
Capability: Volunteer Management
Observation 4.1: Area of Improvement
Analysis: It was difficult for those staff members assisting with the registration of
volunteers to keep track of the necessary items and documents they needed to complete
before going out into the field (i.e. signed consent forms, photo waiver).
Recommendations: Have a checklist for staff managing volunteer registration to
improve efficiency.
Update: When teams returned to the field on November 6th
the support staff was
provided with a checklist to identify any missing documents or materials needed from the
volunteers to participate in the exercise. Registration was completed efficiently.
Observation 4.2: Area of Improvement
Analysis: It was challenging at times for the team leaders to keep track of all the
important details needed to guide the teams before and during the exercise.
Recommendations: Develop training and a checklist for the team leaders to be done
prior to the health assessment. This will allow them to provide important information and
reminders in an organized manner prior to the departure of teams.
Update: On 11/6, the team leaders had a checklist of important details and reminders to
review with their respective teams before their departure to the field. This allowed for
better organization and delivery of critical information.
Observation 4.3: Strength & Area of Improvement
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Analysis: The training conducted the Friday before the survey day was adequate. The
volunteers were equipped with knowledge about following the CASPER protocol, using
the Capturx pens, interacting with community members from different cultural
backgrounds and ensuring safety. Some volunteers would like to spend more time
reviewing the maps and using the pens prior to field deployment. However, the team
leaders felt they needed a separate training specifically on being a team leader where they
could talk about potential issues ahead of time.
Recommendations: Dedicate a larger portion of time to spend reviewing the maps and
pens during the training. Develop training and a just-in-time training for team leaders
that can be done prior to the general training for volunteers.
Observation 4.4: Area of Improvement
Analysis: There were several individuals that wanted to volunteer to participate in the
health assessment but were unable to make it to the training because of their schedules.
Recommendation: We can offer a training session at night for people that work during
the day.
Observation 4.5: Area of Improvement
Analysis: When teams were getting ready to begin their surveys, they grabbed the back
packs without realizing that each bag was numbered and associated to a team. The teams
were able to correct the situation and retrieve the appropriately numbered bag. Each bag
had the same equipment but it could have caused issues with accountability.
Recommendations: Nashua DPH&CS should clarify during the training that the bags are
numbered by team. Assign support staff to distribute the bags to the appropriate teams. A
sign out sheet would be beneficial to have as well.
Update: Before teams were sent out into the field on November 6th
support staff called
each team by number and handed them their appropriate back pack and had them sign out
the maps and hand held radios. This ensured that each team received the appropriate
assigned equipment.
Capability: Planning and Preparation Observation 5.1: Area of Improvement
Analysis: When conducting the surveys door-to-door, some teams encountered members
from the elderly populations who were afraid or anxious of them because they were
unaware of the exercise.
Recommendations: Explore ways to better communicate with the elderly community.
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Collaborate with organizations, such as the Senior Center, that provide services and
outreach to Nashua’s elderly to help inform these populations about the exercise.
Observation 5.2: Area of Improvement
Analysis: Most apartment complexes allowed us to conduct the survey on their premises.
However, there were some that did not allow us to do so. This prevented us from
gathering valuable epidemiological data from those neighborhoods.
Recommendation: We can contact these apartment complexes well in advance and try to
put the survey on the agenda of the board meetings to get their support. This will allow us
to fully explain the importance of having the data from their residents as part of the CHA.
Observation 5.3: Area of Improvement
Analysis: It takes a long time to print the answer sheets on digital paper for the survey.
Approximately 3.5 hours to print 250 answer sheets.
Recommendation: Have a generic survey answer template that can be used for a basic
survey and have them already printed out on a several copies of digital paper.
Observation 5.4: Strength
Analysis: Prior to the health survey on 10/23 and 11/6 the Health Specialist worked with
Division staff and the regional Media Advisory Group to alert residents to the health
survey. Flyers were created and distributed at apartment complexes, schools, and other
buildings of opportunity. A short PSA with the assistance of the Mayor was put together
and aired on Ch 16 and Ch 99. The Nashua School District sent a message via eNews to
parents and organizations from the Advisory Board shared the information with their
clients and staff. The Nashua Telegraph released an article on the health survey prior to
10/23 (the link can be found at http://www.nashuatelegraph.com/news/885476-
196/survey-takes-aim-at-health-needs.html).
Observation 5.5: Strength
Analysis: The volunteers wore red vests with name badges while in the field. This
provided credibility when interviewing residents. The team leaders also had copies of
their teams’ map and walking path. This allowed team leaders and support staff to locate
volunteers if needed and provided accountability of the volunteers.
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Section 4: Conclusion
Overall, the Health Survey 2010 exercise was a success. The volunteers were adequately
prepared and equipped to survey Nashua’s residents. They maintained communication
with the command post at critical points throughout the day, even when primary modes
of communication were non-functioning. At the command post, the support staff logged
and addressed important issues and volunteer needs. Important epidemiological data on
the health of Nashua was collected in a friendly, efficient and culturally competent
manner. Lessons learned for future exercises include expanding the communications
equipment so volunteers can remain connected to the command post and team leaders
even in remote areas, and better utilizing the Incident Command System. Many of these
areas for improvement were enhanced for our return to the field on November 6, 2010.
We have organized an After Action Conference for January 2011 to review the overall
results from this exercise and discuss strategies for improvement for future exercises.
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Appendix A: Improvement Plan
This IP has been developed specifically for the Greater Nashua Public Health Region and DPH&CS as a result of the Health Survey
2010 conducted on October 23, 2010 and November 6, 2010. These recommendations draw on both the After Action Report and the
After Action Conference. Note: The MACE stands for Multi-Agency Coordinating Entity and is synonymous with the Incident
Command Post or Emergency Operations Center.
#Capability Recommendation Corrective Action Description Responsible
Party Completion
Date
Communication Nashua DPH&CS should reinforce
to the survey teams the importance
of the communications checks. One
individual on each team should be
assigned as the communication lead
and be responsible for answering
calls from the MACE and/or team
leads.
On November 6, 2010, team
leaders reinforced that their teams
must check in with the command
post. Teams also used handheld
radios which functioned perfectly
in the field. This facilitated
immediate and efficient
communication with the command
post.
Exercise
Coordinator
11/6/10
MACE team should have a bank of
phones for the survey teams to call
into with support staff answering
the calls. Any issues or concerns
should be pushed up to the team
leads.
On November 6th
, 2010, teams
were required to check in after
completing their surveys and not
when they started the survey. The
coordinators also extended the
walk on the maps for each team.
This significantly decreased the
number of calls coming in at once.
Team
Leaders
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Look into Capturx Mobile
technology to assist in the
timeliness of the data and
accountability of volunteers
Regional
Public Health
Preparedness
Coordinator
EOC
Management
Nashua DPHS&CS should have IT
support on duty or on standby
during exercises and real world
events to troubleshoot and solve IT
issues. It would also be beneficial
to have the MACE account
established with a
password/account that does not
expire.
In November 2010, IT reactivated
the MACE account with an
account that will not expire.
Explore ways to contact IT 24
hours a day and during
emergencies. Add to MACE Plan.
Regional PH
Preparedness
Coordinator
11/2010
EOC
Management
For safety and efficiency purposes
the MACE staff should ensure that
all support staff and teams that are
sent into the field, are in two or
more person teams.
Add to the Volunteer Annex Regional PH
Preparedness
Coordinator
or Safety
Officer
Volunteer
Management
Nashua DPH&CS should clarify
during the training that the bags are
numbered by team. Assign support
staff to distribute the bags to the
appropriate teams. A sign out sheet
would be beneficial to have as well.
On November 6th
support staff
called each team by number and
handed them their appropriate
back pack and had them sign out
the maps and hand held radios.
This ensured that each team
received the appropriate assigned
equipment.
Team
Leaders
11/6/10
Volunteer Have a checklist for staff managing On November 6th
the support staff Support Staff 11/6/10
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Management volunteer registration to improve
efficiency.
was provided with a checklist to
identify any missing documents or
materials needed from the
volunteers to participate in the
exercise. Registration was
completed efficiently.
Develop a training targeted
specifically for the team leaders.
This training will review important
operational functions for the team
leaders which includes how to track
volunteer issues, how to use the
radios, etc.
Develop job action sheets for the
team leaders and support staff.
Project
Coordinator
and Team
Leaders
Develop training on how to debrief
teams before heading to the field
and a checklist for the team leaders
to keep track of important
reminders.
On November 6, team leaders had
a checklist of important details
and reminders to review with their
respective teams before their
departure to the field. This
allowed for better organization
and delivery of critical
information.
Exercise
Coordinators
11/6/10
Planning and
Preparation
Increase communication with those
from various populations (i.e eldery
Add to Risk Communication
Annex
Regional PH
Preparedness
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and functional needs) to keep them
informed and encourage their
participation in the survey.
Collaborate with organizations that
provide services to them.
Coordinator
and the
Public
Information
Officer
Set up meetings with the apartment
complex board members to ask for
permission to survey the residents
of the complex. Collaborate with
other City agencies that my already
have a relationship with the board.
Regional PH
Preparedness
Coordinator
and the
Public
Information
Officer
Create a basic or generic survey
answer template to be printed on
digital paper ahead of time.
Exercise
Coordinator
Ensure that at least 3 people in the
Division understand how to
perform a rapid needs assessment
and can use the Capturx software.
Epidemiologi
st
Note: The following ideas will be kept in the mind for future exercises
1. Training sessions will be offered at alternate times to accommodate volunteers with various schedules.
2. Additional staff members will be trained to participate in operational exercises. This will allow them to be familiar with the
different positions and responsibilities and equip them to serve in any of the positions needed in the exercise.
3. Publicity for volunteer recruitment will be launched well in advance to encourage participation. Collaboration with the
technical schools and college may help with recruitment, as the school may consider integrating the exercise into their
programs.
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Appendix B: Participant Feedback Summary
Community Health Survey Evaluations from October 23, 2010
Overall, the volunteers had a positive experience going out into the community and
conducting the survey. They felt the training was adequate for the exercise and they were
well received by the community. They acknowledge the difficulty in communicating with
the command post and their team leaders because the walkie talkies did not function at all
in all parts of the City. Refer to the below table for specific responses to the evaluations
for the health survey and for using the Capturx digital pens and Anoto digital paper.
Question Scale # of
responses (%)
1. Now that I have completed the survey process, I
think the training on Friday was adequate to prepare me
for the day of the survey. (n=30)
Strongly agree 1 23 (77%)
2 5 (17%)
3 1 (3%)
4 0 (0%)
Strongly disagree 5 1 (3%)
2. I had the necessary supplies to conduct the surveys in
the community. (n=30)
Strongly agree 1 28 (93%)
2 1 (3%)
3 0 (0%)
4 0 (0%)
Strongly disagree 5 1 (3%)
3. The communication tools (e.g. radios and cell
phones) were in working condition, easy to use, and
adequate for communications during the survey
process. (n=29)
Strongly agree 1 3 (10%)
2 2 (7%)
3 8 (28%)
4 6 (21%)
Strongly disagree 5 10 (34%)
4. The maps and walking paths were easy understand,
use and follow. (n=29)
Strongly agree 1 3 (10%)
2 2 (7%)
3 8 (3%)
4 6 (21%)
Strongly disagree 5 10 (34%)
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5. Overall, how were you perceived by the public while doing the survey?
“I was surprised that minorities were more willing to participate”
“Most people were accepting and welcoming. Others did not want to be bothered or thought we were
trying to talk about politics”
“Well”
“Good”
“Very well, interested to help out”
“Everyone we spoke to was aware of survey. Well received”
“Fine - most people willing to participate, some getting impatient by the end”
“The public was gracious and accepting, except for one person who was not hostile, but felt we might
be part of Obama administration or part of the health care policy that recently passed.”
“Fairly ambivalent”
“Overall Ok”
“Mostly the public was very receptive. No bad comments”
“Welcomed. [Most] expected us.”
“Very well”
“People were extremely receptive and apologized if they didn’t have time or were unable to take the
survey”
“No problems - typically neutral”
“I think we were perceived well by the public while doing the survey.”
“We were very well received in general - had one guy who was a little rude, but the doorbell woke
him up, so…We had 2-3 elderly folks and they all seemed a little nervous and declined to take the
survey”
“Some of them refused, some reason out that they are busy don’t have time to do interview”
“Very well for those who were home”
“Received well. ID’s and vests/name on vests helped show who we were”
“It varied. About half were interested and open and the other half were rushed and not interested”
“Overall, some were very helpful, but on the other hand some, especially ethnic groups refused to
participate”
“Ok I think. Some people didn’t have time”
“Very friendly, very willing - the unwilling were still nice”
“Generally, well received”
“Welcomed by people willing to participate. Many others were less “friendly”.”
“Overall good”
“They were happy they were helping the community”
“Well. Most people were friendly and glad to see us in the community”
“The only challenge was finding people who were at home and awake during the morning hours- got
much better in the afternoon. Had about as many decline to take the survey as there were participants.”
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6. Comments & Suggestions: If you rated a statement as “strongly disagree” or “disagree”
please explain why.
“The radio didn’t work at all. We were able to use cell phones fine.”
“The radio was not working. Maps a little confusing.”
“There were a lot of materials to carry and juggle. Might be good to conduct on small hand held
computer.
Also ? use GPS and mark homes - already programmed - could get more done.”
“Great training for the task and adequate publicity”
“Radios did not work. Cell phones awkward at beginning of interview, so just called in at the end.”
“Walkies did not work well, needed to use cell phones. More help/time with maps and longer walking
route would
have been helpful.
“Radios worked only intermittently. The maps were very confusing and often inaccurate”
“Radios didn’t work well. Phone was awkward. The teams should be one Nashua and one volunteer.”
“Radios did not work at all. Recommend placing Nashua residents with non-Nashua residents”
“Walkie talkie radios did not work”
“Walkies did not function. Personal cell fine.”
“The radios were not a good source of communication because the reception was not good.”
“1. The training pretty well covered everything
2. Everything we needed was there and then some!
3. Radio reception was spotty, so we just used our cell phones.
4. Had one question about the route at the very beginning, but no problems other than that.”
“Possible make an early start like 9-9:30 am. Possible give another map for continuation if the map
finished.”
“Have a “mini” stretching exercise before going to the survey- I mean during the briefing prior to
survey-just for warmth up…”
“It was difficult in multi-unit homes. They weren’t “apartment complexes” but when you got to the
front door it was locked, so you couldn’t know on the actual apartment”
“The questions on survey in Spanish was not so clear, whoever translated should have it check by
someone else it was a lot of mistakes”
7. Would you like to be involved in future activities?
All 30 respondents replied “yes”.
“Elders who get scared when knocking at the door. One family - 1st refused but when we are leaving
they called us because they said they need help in their health insurance-so they like to participate…”
“Was a pleasant experience overall. No’s get disappoint but yes’s were exhilarating!”
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Capturx Digital Pens and Anoto Digital Paper Evaluations
Question Scale # or
responses
1. How would you rate your overall experience with the pens? (n=21)
Poor 0 (0%)
Fair 1 (5%)
Satisfactory 5 (23%)
Good 11 (52%)
Excellent 4 (19)
2. How helpful was the training in preparing you for use of the pen? (n=22)
Not Helpful 0 (0%)
Somewhat
Helpful 0 (0%)
Helpful 9 (41%)
Very Helpful 13 (59%)
3. Did you experience any challenges? If so, what were they?
“No”
“Not always sure the pen was on”
“No”
“No”
“Keeping to move the paper for the legend is awkward.”
“No”
“None - worked very well”
“Cost of pen made me concerned about losing it. At times the pen felt like it didn’t vibrate after
opening it.
It vibrated when point was placed on paper.”
“Making the map (because houses were very small)”
“None”
“No”
4. Do you have any recommendations or additional comments?
“No challenges with the pen”
“No”
“No”
“The ink does not always flow well, need to know if we should retrace unclear lines like on the map
legend symbols.”
“None”
“It was a good experience.”
“Can’t think any, but if I do, I know where to find you!”
“Teaching us how to erase and fix errors.”
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“A little more “hands on” with map and pen applications.”
“Took some time to develop routine for remembering to touch the icon before and after use.”
“No”
“No”
Community Health Survey Evaluations from November 6, 2010
Overall, the volunteers had a positive experience going back out into the community and
conducting the survey. They felt the training was adequate for the exercise; they were
well received by the community and had a lot of fun. Almost all volunteers noted that the
communications systems were adequate for the exercise. This validates that handheld
radios should be used for future exercises rather than walkie talkies.
Question Scale # of
responses (%)
1. Now that I have completed the survey process, I
think the training on Friday was adequate to prepare me
for the day of the survey. (n=18)
Strongly agree 1 15 (83%)
2 2 (11%)
3 1 (5%)
4 0 (0%)
Strongly disagree 5 0 (0%)
2. I had the necessary supplies to conduct the surveys in
the community. (n=20)
Strongly agree 1 19 (95%)
2 1 (5%)
3 0 (0%)
4 0 (0%)
Strongly disagree 5 0 (0%)
3. The communication tools (e.g. radios and cell
phones) were in working condition, easy to use, and
adequate for communications during the survey
process. (n=20)
Strongly agree 1 17 (85%)
2 3 (15%)
3 0 (0%)
4 0 (0%)
Strongly disagree 5 0 (0%)
4. The maps and walking paths were easy understand,
use and follow. (n=20)
Strongly agree 1 11 (55%)
2 4 (20%)
3 4 (20%)
4 1 (5%)
Strongly disagree 5 0 (0%)
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5. Overall, how were you perceived by the public while doing the survey?
“Some were aware of this project by the media. Some had to be “talked into” doing the survey. Many
were not home - disappointing.”
“Very well.”
“Some residents were skeptical of us in spite of our identification, etc. On the most part, people were
receptive.”
“I think we were perceived well”
“Most individuals were compliant or reasonably easy to persuade”
“Cooperative/friendly”
“Friendly and approachable”
“Well”
“Very good. Very welcome”
“Very well”
“Everyone was very nice and most were willing”
“Overall I think the public respected and participated us as a member of Nashua Public Health”
“Very well”
“The public was welcoming”
“Well overall. One person refused because he felt the survey would not be confidential”
“The most of the people were kind and nice”
“Well received by all household but one who seemed to be having a bad day, not related to our
interruption in her day. We did have a couple stop to inquire about our activity, and express very
negative feelings with lack of actions taken in the community re existing negative problems i.e. bed
bug infection problems, also lack of services for drug addicts etc.”
“Generally we were positively accepted by the community although there’s few who don’t want to
participate and there’s one we encountered that have very bad experience with public health and
thought that she can’t have any solution with City’s problem.
“It was okay. The walk was long but it was fun to meet people.”
“We were well received by those who were willing to take the survey. Otherwise my location wasn’t
very receptive and closed the door in our faces.”
“Sometimes discouraged by the rejection.”
6. Comments & Suggestions: If you rated a statement as “strongly disagree” or “disagree”
please explain.
“Great Preparation, planning, execution of surveys. Wonderful PH staff - Ashley and Debbie…deeply
appreciated this opportunity to serve. Thanks!”
“I had trouble understanding the maps - luckily my partners was able to read them.”
“#’s and roads not there”
“Excellent experience - maps not always accurate.”
“Everything was well thought out”
“I think that this was a great experience and everything was well put together.”
“The maps wasn’t clear about some houses that we haven’t to visit”
“Program was very well organized. Details left nothing to be missed - easy to follow.”
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7. Would you like to be involved in future activities?
18 out of 20 volunteers responded “yes”.
“We need to do it again in a regular basis and hope we can find solutions to our community problem”
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Appendix C: Exercise Events Summary Table
Table 1: Health Survey 2010; 10-23-10 Events Summary
Date Time Event/Action
10/23/10 0700 Division CHA Team Arrives for set-up at SNHMC
10/23/10 0800 Volunteers sign-in and get equipment
10/23/10 0830 Review key points make sure everyone has their maps, surveys,
etc.
10/23/10 0930 Teams leave SNHMC and go to their first neighborhood
10/23/10 1000 Teams arrive at their first house
10/23/10 1140 Support staff/drivers take lunch out to the teams
10/23/10 1200 Teams take a 30 minute lunch (mandatory)
As teams finish, they report back to the DPH&CS
10/23/10 1600 All teams must report back to DPH&CS
10/23/10 1615 Wrap-up/Hotwash
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Table 2: Health Survey 2010; 11-6-10 Events Summary
Date Time Event/Action
11/6/10 0700 Division CHA Team Arrives for set-up at SJH
11/6/10 0800 Volunteers sign-in and get equipment
11/6/10 0830 Review key points make sure everyone has their maps, surveys,
etc.
11/6/10 0930 Teams leave SJH and go to their first neighborhood
11/6/10 1000 Teams arrive at their first house
11/6/10 1200 Teams take a 30 minute lunch out in the field (mandatory)
Lunch was provided to teams before departure in thermal
lunchboxes.
11/6/10 1600 All teams must report back to DPH&CS
11/6/10 1615 Wrap-up/Hotwash
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Appendix D: Acronyms
Table 3: Acronyms
Acronym Meaning
CASPER Community Assessment for Public Health Emergency Response
CHA Community Health Assessment
CDC Centers for Disease Control and Prevention
DPH&CS City of Nashua Division of Public Health & Community Services
EOC Emergency Operations Center
IOF Initial Operating Facility
JIT Just-in-Time Training
JFO Joint Field Offices
JOC Joint Operations Center
MACE Multi-Agency Coordinating Entity
MACC Multi-Agency Coordination Center
NOC National Operating Center
NRCC or (RRCC) National (or Regional) Response Coordination Center
RNA Rapid Needs Assessment
SNHMC Southern New Hampshire Medical Center
SJH St. Joseph’s Hospital
.
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Appendix E: THANK YOU TO OUR
VOLUNTEERS!!!
American Red Cross
Ashley Pushkarewicz
City of Nashua, DPH&CS
Victoria Alabi
Mike Amichetti
Theresa Calope
Ashley Conley
Patty Crooker
Debbie Daniels
Corinn Dembkoski
Janet Graziano
Sue LaPointe
Meredith Lyons
Al Matkowsky
Sandy Mulcahy
Luis Porres
Howard Price
Barbara Scacco
Kerran Vigroux
Betty Wendt
Community Members
Jim Dembkoski
Linda Fielding
Dartmouth-Hitchcock
Tracy Bennett
Lorraine Schreib
Gateways Community Services
Kristen Leppanen
Jo-Ann Sheehan
Greater Derry Medical Reserve Corps
Maria Rocheleau
Greater Nashua Mental Health Center at Community Council
Joan Haskell
Jennifer McGrath
Hillsborough County Amateur Radio Emergency Services
Jim Blaine
Nashua Area Health Center
Mariellen Durso
Mara Lessard
Justine Nims-Largy
Maria Cecilia Pereira
Janice Watson
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Nashua Community College
Emma DeLosAngeles
Angela Mercado
Tresa Ann O'Connor
Nashua Police Athletic League
Leah Nora Chauvin
Nashua Police Department
Ed Lecius
NH Dept. Health & Human Services
Adnela Alic
Rick Cricenti
Melissa Gravilla
Deborah LaFave
Darlene Morse
Carole Totzkay
Sandy Weld
NH HSEM
Fallon Reed
Rivier College
Sandra Harrington
Elizabeth Kilar
Susan Mika
Edlie Rivas
Danielle Spinhirn
Sarah Stauff
Kristen Tyler
Emily Veloso
Southern NH Medical Center
Mark Hastings
Southern NH Services
Amy Moutenot
St. Joseph Hospital
Fran Dupuis
St. Louis De Gonzague Parish
Carmen Dussault
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Pictures from the Health Survey
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