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Exercise Program
Topic Collection
August 31, 2023

Topic Collection: Exercise Program

Discussion- and operations-based exercises are critical for healthcare providers, public health agencies, and other community stakeholders to use to evaluate the efficiency and efficacy of policies, plans, and procedures in meeting response goals. They can also be used to determine whether equipment, training, and facilities are adequate to support their mission. The proper evaluation of any exercise provides the necessary data to revise/reinforce existing policies, plans, procedures, training, facilities, and/or equipment. The following resources highlight select templates, courses, and guidance documents that can help planners develop comprehensive exercises to test the healthcare and public health response to any type of disaster.

Access the Training and Workforce Development Topic Collection for guidance on public health and healthcare emergency/disaster competencies and capabilities. Additional exercise resources may be found throughout other Topic Collections.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning for Health Care Coalitions.
The speakers in this webinar discussed exercise templates designed to help manage patients with highly pathogenic infectious diseases; explained how exercises support ASPR's regional, tiered approach; and shared their experiences planning and executing exercises for Ebola and other special pathogens.
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California Association of Health Facilities. (n.d.). Disaster Preparedness Program Exercises and Drills. (Accessed 1/7/2020.)
This webpage provides a number of resources for healthcare facilities (including long-term care facilities) regarding drills, tabletop exercises, after action report and improvement plan templates, and training resources. It was developed by CAHF to assist healthcare facilities to comply with the new CMS EP Rule.
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Centers for Medicare & Medicaid Services. (2017). Information to Assist Providers and Suppliers in Meeting the New Training and Testing Requirements of the Emergency Preparedness Requirements for Medicare & Medicaid Participating Providers and Suppliers Final Rule.
This memorandum provides information to assist providers and suppliers in meeting the Training and Testing requirements of the new Emergency Preparedness Final Rule that was published on September 16, 2016 (81 FR 63860) and became effective on November 15, 2016.
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Federal Emergency Management Agency. (n.d.). After-Action Report/Improvement Plan (AAR-IP) Template. (Accessed 1/15/2020.)
Evaluators can use this template to monitor and incorporate corrective actions on a continual basis to improve the preparedness and planning process.
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Federal Emergency Management Agency. (n.d.). HSEEP Policy and Guidance. (Accessed 9/22/2022.)
This website contains links to templates emergency planners can tailor for exercise program management, design and development, conduct, evaluation, and improvement planning. A link to exercise evaluation guides is also provided.
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Federal Emergency Management Agency (FEMA). (2018). IS-120.C: An Introduction to Exercises.
This five-hour, interactive, web-based training course introduces the basics of emergency management exercises and identifies the five phases of the exercise process.
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Fruhwirth, K., Chambers, G., Shields, S., and Torres, R. (2012). Conducting Drills and Exercises: A Guide for Hospitals.
This guidebook (specific to Los Angeles County) includes general information on exercise design, creation and evaluation. Chapter 5 includes detailed guidance for scenario development, as well as numerous sample scenarios planners may find useful in developing their own exercises.
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Harvard T.H. Chan School of Public Health. (2019). Emergency Preparedness Research, Evaluation & Practice (EPREP): Drills and Exercises.
Public, private, and non-governmental organizations can use the resources on this page to prepare for and respond to emergencies of all types. Resources, including an exercise evaluation toolkit, are focused on design and facilitation, evaluation, exercise resources, and hospital-specific exercises.
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Illinois Emergency Medical Services for Children. (2016). Addressing the Needs of Children in Disaster Preparedness Exercises, 2nd Edition.
This document includes guidance and tools to assist planners with including pediatric-focused scenarios and considerations in their disaster preparedness exercises. It includes discussion of exercise components by setting; how to incorporate children into disaster exercises; and sample exercise scenarios.
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Johns Hopkins University. (2016). Public Health Preparedness Exercise Program: From Design to Evaluation. (Free registration required.)
The speaker highlights design, implementation, and evaluation of public health emergency preparedness exercises in this three-part 1.5 hour training.
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Northwest Health Services Coalition. (2019). Exercise/Drill Materials.
This web page includes links to a variety of templates (e.g., after action reports, drills/tabletop examples, scenarios, and evaluation guides) healthcare facilities can tailor to suit their needs.
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Savoia, E., Agboola, F., and Biddinger, P. (2012). Use of After Action Reports (AARs) to Promote Organizational and Systems Learning in Emergency Preparedness. International Journal of Environmental Research and Public Health. 9(8): 2949-2963.
The authors performed a structured review of after-action reports to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness exercises. Key areas of common problems were identified from a search of the Lessons Learned Information System database that may help develop objectives for community testing.
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Skryabina, E., Reedy, G., Amlot, R., et al. (2017). What is The Value of Health Emergency Preparedness Exercises? A Scoping Review Study. International Journal of Disaster Risk Reduction. 21: 274-283.
The authors conducted a literature review on the effects of exercises on emergency response within the healthcare community. They found that exercises were effective at “improving participants’ knowledge of emergency activities, policies and procedures and improving overall competence and confidence,” and “improved perceptions of preparedness, and improved understanding of individual roles, and roles of partners.” They note that it is unclear if these improvements positively impact actual emergency response.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Hospital Surge Evaluation Tool.
This tool can be used by hospital emergency planners, administrators, and other personnel to both assess and enhance their facility’s mass casualty surge plans. Emergency department and inpatient personnel must find appropriate space for waves of incoming virtual patients. It includes evaluation tools specific to emergency department triage and hospital incident command.
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University of Arkansas. (2016). Access and Functional Needs: Injects for Use by Local Emergency Planning Personnel in Emergency Management Tabletops and Exercises.
This 24-page document provides disability-related materials for use by local emergency planning personal in emergency exercises and drills. They are based on listening sessions with people with intellectual and developmental disabilities, their family members, and emergency responders.
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  • Eileen Robichaud This link is broken. It no longer works. Please update the link.
    3/2/2023 1:37:26 PM
Virginia Department of Health. (2018). Emergency Preparedness Exercise Planning for Healthcare Facilities.
This presentation reviews exercise planning basics to assist healthcare facilities with meeting the exercise requirements set forth in the 2016 Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness (EP) Rule, including examples for each step of the exercise planning process. It also includes a 90-minute tabletop exercise focused on an extreme thunderstorm scenario.
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After-Action Reports

* Federal Emergency Management Agency. (n.d.). After-Action Report/Improvement Plan (AAR-IP) Template. (Accessed 1/15/2020.)
Evaluators can use this template to monitor and incorporate corrective actions on a continual basis to improve the preparedness and planning process.
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Health Care Association of New Jersey. (2012). Project ESCAPE (Evaluate Surge Capacity and Prioritized Evacuation) Full Scale Exercise: After Action Report/Improvement Plan.
This After Action Report provides a summary of the Central West Medical Coordination Center regional mass casualty exercise. Organizers developed two objectives for this exercise: evaluate the ability to evacuate residents from a long-term care facility and evaluate medical surge into an acute care hospital. This document can also serve as a template for other community exercises.
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National Mass Care Council. (2015). Critical Mass 2015: National Mass Care Exercise; Mass Care/Emergency Assistance After-Action Report.
This after-action report provides a summary of outcomes related to the conduct of the 2015 National Mass Exercise held in Austin, Texas. The report also provides a synthesis of comments provided by participants during the hot wash at the conclusion of the exercise.
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Northwest Healthcare Response Network. (2018). Regional Surge and Regional Surge Squared Functional Exercises: After Action Report (AAR)/ Improvement Plan (IP).
This After-Action Report/ Improvement Plan (AAR/IP) clearly describes the scenario, objectives, and outcomes from a full-scale exercise conducted in 2017 to test surge capacity and associated regional coordination among partners in the Northwest Healthcare Response Network, in coordination with the National Disaster Medical System. It may be referenced by other coalitions and/or facilities to develop their own respective AARs, as well as to develop scenarios and objectives for similar exercises.
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Region 9 Healthcare Coalition. (2017). After-Action Report/Improvement Plan for: Region 9 Healthcare Coalition Evacuation Situational Awareness Exercise: Northern Sub-Region. Spokane Regional Health District.
This intent of the exercise was to evaluate three objectives related to patient placement, patient transportation, and situational awareness during a hospital evacuation exercise utilizing a regional coordination element. This document summarizes the exercise strengths and areas for improvement.
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San Francisco Department of Public Health, Charles Schwab & Co., Inc., and San Francisco Department of Emergency Management. (2007). 2007 Mass Antibiotic Dispensing Exercise (MADE07) After Action Report.
This after-action (AAR) report describes a full-scale exercise developed to test the capability of San Francisco Department of Public Health’s (SFDPH) plan for rapid mass prophylaxis dispensing in an outdoor aerosolized anthrax release scenario. Pediatric issues (e.g., medication dispensing) are addressed throughout the AAR.
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Savoia, E., Agboola, F., and Biddinger, P. (2012). Use of After Action Reports (AARs) to Promote Organizational and Systems Learning in Emergency Preparedness. International Journal of Environmental Research and Public Health. 9(8): 2949-2963.
The authors performed a structured review of after-action reports to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness exercises. Key areas of common problems were identified from a search of the Lessons Learned Information System database that may help develop objectives for community testing.
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Discussion-Based Exercise Templates: Active Shooter

California Department of Public Health. (2017). Statewide Medical and Health Exercise Situation Manual Template.
This resource is a detailed template that may be completed and used to conduct a tabletop exercise focused on active shooter/terrorism mass casualty incidents.
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California Hospital Association. (n.d.). Drills and Exercises. (Accessed 1/7/2020.)
This website features links to checklists, reference guides, compliance information, and all of the materials needed for a hospital active shooter interactive tabletop exercise.
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Health Care Association of New Jersey. (2014). LTC Shots Fired Tabletop Exercise Situation Manual.
This tabletop exercise can help healthcare facility executives and team members address key active shooter issues through a series of facilitated discussions. The completed Situation Manual contains detailed objectives, scenario information, and discussion questions that may be referenced by other organizations when designing a similar exercise.
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Discussion-Based Exercise Templates: Cyber

U.S. Department of Homeland Security, Office of Infrastructure Protection. (2013). DHS Cyber Tabletop Exercise (TTX) for the Healthcare Industry [Exercise Materials].
Healthcare organizations can download this zip file which contains a package of materials that can help them plan and organize a cyber tabletop exercise.
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Discussion-Based Exercise Templates: Emerging/Infectious Disease

ASPR TRACIE. (2021). Step-by-Step Guide to Implementing the Coalition Infectious Disease Annex TTX Template (PDF).
This guide is part of a toolkit that can help emergency planners create an interactive, discussion-based exercise focusing on impacts to healthcare coalition and healthcare facilities caused by large numbers of patients seeking healthcare following exposure to an infectious agent.
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Centers for Disease Control and Prevention. (2017). Pandemic Influenza Electronic Exercise Tool.
This tool provides community planners with an easy-to-use format for developing and conducting a discussion-based exercise using email or other electronic format, and allows participants to take part in the exercise from various locations with limited interruption to their daily work routine. The exercise is conducted during a 3-week timeframe, allowing the participants to respond in "real time.”
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Centers for Disease Control and Prevention (CDC). (2018). Pan Flu Scramble Exercise.
This website provides access to the Pan Flu Scramble Exercise, a discussion based tabletop exercise that enables healthcare entities to test their patient surge plans. The exercise also addressed Hospital Preparedness Program and Public Health Emergency Preparedness capabilities.
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National Ebola Training and Education Center. (n.d.). NETEC Exercise Templates. (Accessed 3/17/2021.)
This web page includes links to various Homeland Security Exercise and Evaluation Program-compliant templates to assist healthcare coalitions, frontline facilities, assessment hospitals, state-designated Ebola treatment centers, regional Ebola and special pathogen treatment centers, and their respective response partners in the planning and conduct of exercises on the identification, assessment, treatment, management, transport, and transfer of high risk patients. The site includes templates for drills, tabletops, functional, and full-scale exercises. There is also a beginners guide to assist users new to exercise planning.
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Office of the Assistant Secretary for Preparedness and Response. (2020). Coronavirus Disease 2019 (COVID-19) Fatality Management Tabletop Exercise. U.S. Department of Health and Human Services.
This coronavirus fatality management tabletop exercise can be used by government, private sector, and nonprofit organizations. Access the Situational Manual here: https://files.asprtracie.hhs.gov/documents/covid19-fatality-management-ttx-sitman-25march2020-508.docx. The Situation Manual provides exercise participants with a hypothetical scenario that depicts numbers of confirmed COVID-19 cases and deaths at the state, regional, and national levels over a period of 40 days and includes discussion questions regarding the following topics: coordination of fatality management operations; information collection and reporting; legal and regulatory considerations; supply chains and resource management; infection control; continuity of operations; mental and behavioral health services; and public messaging and risk communications. The accompanying slide deck provides an overview of the scenario to set the stage for discussion.
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Office of the Assistant Secretary for Preparedness and Response. (2020). Coronavirus Disease 2019 Fatality Management Tabletop Exercise Situation Manual. U.S. Department of Health and Human Services.
This Situation Manual and accompanying slide deck (available at https://files.asprtracie.hhs.gov/documents/covid19-fatalitymanagement-ttx-facilitation-deck-25march2020-508.pptx) are designed to assist government, private sector, and nonprofit organizations in identifying issues or challenges that may arise when conducting fatality management operations in response to the COVID-19 pandemic. The Situation Manual provides exercise participants with a hypothetical scenario that depicts numbers of confirmed COVID-19 cases and deaths at the state, regional, and national levels over a period of 40 days and includes discussion questions regarding the following topics: coordination of fatality management operations; information collection and reporting; legal and regulatory considerations; supply chains and resource management; infection control; continuity of operations; mental and behavioral health services; and public messaging and risk communications. The accompanying slide deck provides an overview of the scenario to set the stage for discussion.
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TALON Preparedness Partners. (2015). TALON Ebola Preparedness Tabletop Exercise: Situation Manual.
This situation manual was developed for participants of an Ebola Virus Disease Regional Network Table Top Exercise. It includes scenarios and related questions, and several appendices, including links to helpful resources.
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University of Washington, Northwest Center for Public Health Practice (NWCPH). (2015). Communicating During Emergencies: A Pandemic Flu Tabletop Exercise. (Site requires free registration).
This tabletop exercise enables participants to identify strengths and gaps in policies and procedures as it relates to communication systems during a major multi-agency pandemic impacting a large county.
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Ventura County Health Care Coalition. (2018). Emerging Infectious Disease Tabletop Exercise Situation Manual.
This resource is the detailed Situation Manual for a leptospirosis-focused Tabletop Exercise conducted by the Ventura County Health Care Coalition prior to the statewide full-scale exercise it participated in that also focused on emerging infectious disease.
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Discussion-Based Exercise Templates: Evacuation

Arkansas Health Care Association. (2017). Evacuation Drill for Long-Term Care Facilities.
This document provides guidance to long-term care facilities that are evaluating their preparedness levels for an evacuation. It contains the materials needed to conduct a simulated evacuation using a tabletop exercise.
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District 1 [Michigan] Regional Medical Response Coalition. (2010). Situation Manual: Shelter-In-Place/Evacuation Tabletop Exercise: Long Term Care Facility.
This Situation Manual includes exercise materials from Michigan, where exercise participants were given the tools to implement and evaluate the Long Term Care Facility (LTC) tabletop exercise. The purpose of this exercise was to provide a forum for LTCs and other organization to participate in a facilitated discussion regarding their roles and responsibilities during shelter-in-place and evacuation emergencies.
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Michigan Region 6. (2010). Evacuation Drill for Long Term Care Facilities.
This guidebook is designed to help long-term care facilities evaluate their preparedness for an evacuation. It contains the materials necessary to conduct a simulated evacuation using a tabletop exercise.
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Discussion-Based Exercise Templates: General

Arizona Department of Health Services. (2015). Arizona Crisis Standards of Care Tabletop Exercise Situation Manual.
This is the Situation Manual for a tabletop exercise focused on crisis standards of care (CSC) indicators, tactics, public information capacity, electronic information and triage systems, emergency operation center coordination, information sharing, and healthcare coalition and local jurisdiction involvement. It may be a valuable resource for other jurisdictions planning for similar exercises.
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Association of Healthcare Emergency Preparedness Professionals. (2014). Disaster Exercises.
This website provides links to operations- and exercise-based documents and other resources that can assist healthcare emergency planners with creating, conducting and evaluating exercises.
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* California Association of Health Facilities. (n.d.). Disaster Preparedness Program Exercises and Drills. (Accessed 1/7/2020.)
This webpage provides a number of resources for healthcare facilities (including long-term care facilities) regarding drills, tabletop exercises, after action report and improvement plan templates, and training resources. It was developed by CAHF to assist healthcare facilities to comply with the new CMS EP Rule.
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Federal Emergency Management Agency. (2017). Emergency Planning Exercises for Your Organization.
This website provides links to examples of tabletop exercises that organizations can utilize and adapt in preparation for emergencies.
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Discussion-Based Exercise Templates: Mass Casualty Incident

Alameda County. (2017). Alameda County Statewide Medical and Health Exercise Tabletop Exercise Situation Manual.
This resource is a completed Situation Manual containing objectives, scenarios, and detailed discussion questions by partner type (i.e., hospitals, clinics, law enforcement, etc.) for mass casualty/terrorism incidents.
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National Disaster Medical System 2018 Exercise Workgroup, San Diego County Operational Area. (2018). Exercise Design Team Meeting Summary.
This resource includes information from the exercise design team meeting for a tabletop exercise followed by a functional/full-scale exercise that included activation of the local Federal Coordinating Center (FCC), medical facilities, local government jurisdictions, and health and medical community partners to test the coordination among partners when the National Disaster Medical System is deployed to assist with patient care following a mass casualty incident.
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Shasta County. (2016). Shasta Medical and Health 2016 Mass Casualty Incident Tabletop Exercise 2016 Situation Manual.
This resource is a completed Situation Manual containing objectives, scenarios, and detailed discussion questions by partner type (e.g., hospitals, clinics, and law enforcement) for a train derailment/chlorine spill in a city of about 100,000 persons.
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Discussion-Based Exercise Templates: Natural Disaster

Colorado Community Health Network. (2010). Peak Vista Community Health Centers Wildfire Tabletop (TTX) Disaster Exercise.
This presentation addresses the purpose of the tabletop exercise, describes the wildfire scenario that impacts the community health center, and provides discussion questions for participants.
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Health Care Association of New Jersey. (2012). Mid Summer’s NightMARES: Situation Manual.
This Situation Manual provided exercise participants in New Jersey with the tools to implement and evaluate the tabletop exercise related to long-term care facilities. The purpose of this exercise was to provide participants with an opportunity to evaluate their long-term care facility’s current medical surge capabilities in response to a severe weather event. It focused on the implementation and coordination of internal emergency management plans, policies and procedures, critical decision making, communications capabilities and the ability to manage a disaster situation requiring medical surge or evacuation of residents into the facility’s operations.
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Primary Care Development Corporation, and the National Association of Community Health Centers. (n.d.). Severe Weather Table Top Exercise. (Accessed 1/7/2020.)
This presentation addresses the purpose of the tabletop exercise, describes the severe weather scenario that impacts the community health center, and provides discussion questions for participants.
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* Shakeout. (n.d.). ShakeOut Exercise Manual For Healthcare Organizations. (Accessed 1/7/2020.)
This document provides guidance for healthcare facilities that wish to participate in a ShakeOut (earthquake) exercise in their community. It includes checklists to guide planning for a drill, a tabletop exercise, and a functional exercise.
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* Virginia Department of Health. (2018). Emergency Preparedness Exercise Planning for Healthcare Facilities.
This presentation reviews exercise planning basics to assist healthcare facilities with meeting the exercise requirements set forth in the 2016 Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness (EP) Rule, including examples for each step of the exercise planning process. It also includes a 90-minute tabletop exercise focused on an extreme thunderstorm scenario.
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Discussion-Based Exercise Templates: Pediatric

American Academy of Pediatrics. (2018). Pediatric and Public Health Preparedness Exercise Resource Kit.
This resource kit was developed through a collaboration between the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Its purpose is to “provide the tools and templates to make it easier for states, communities, hospitals, or healthcare coalitions to conduct a pediatric tabletop exercise, which provides participants with the opportunity to discuss and assess preparedness plans and capabilities for a disaster that affects children.”
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Illinois Emergency Medical Services for Children. (2013). NICU/Nursery Evacuation Tabletop Exercise Toolkit.
This toolkit provides various resources and tools developed specifically for exercises, and offers guidance on planning, conducting, and evaluating tabletop exercises focused on the neonatal intensive care unit and nursery population.
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Education and Training

Anzalone, J., Bush, S., Head, B., et al. (2014). National Mass Care Exercise: Helping Build State Mass Care Capability.
This webinar features speakers who discuss the rationale for a national mass care exercise, the Florida exercise experience, lessons learned from the exercise, and applying lessons at the state and local levels. A link to the slides used in the webinar and additional resources are also provided.
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Federal Emergency Management Agency (FEMA). (2018). IS-120.C: An Introduction to Exercises.
This five-hour, interactive, web-based training course introduces the basics of emergency management exercises and identifies the five phases of the exercise process.
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Johns Hopkins University. (2016). Public Health Preparedness Exercise Program: From Design to Evaluation. (Free registration required.)
The speaker highlights design, implementation, and evaluation of public health emergency preparedness exercises in this three-part 1.5 hour training.
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* Primary Care Emergency Preparedness Network. (n.d.). Community Health Center Coastal Storm Exercise Plan. (Accessed 1/7/2020.) New York City Department of Health and Mental Hygiene.
This HSEEP-compliant full-scale/functional exercise planning tool can help planners develop a hurricane-specific operations-based exercise for community health centers. It may be referenced by other healthcare facilities for developing similar exercises.
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Russell, M. (2015). The Healthcare Disaster Exercises Toolkit. (Available for purchase.)
This resource provides exercise planning, implementation and evaluation guidance for internal organizational needs, and mechanisms to participate with community partners. Sample scenarios, victim profiles, and a variety of templates will support exercise development, tracking and corrective actions.
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  • Bridget Kanawati This book is actually available for purchase and you can find it online. ASPR TRACIE cannot promote any particular vendor; therefore a link has not been provided for this resource.
    11/4/2016 10:32:27 AM
  • Jennifer Reid No hyperlink to the toolkit.
    11/4/2016 9:28:41 AM
* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Health Care Coalition Surge Test Tool.
This training video provides an overview of how to use the HHS ASPR Health Care Coalition Surge Test Tool that tests ability to find beds for patients evacuating coalition hospitals.The tool can be found at https://www.phe.gov/Preparedness/planning/hpp/Pages/coaltion-tool.aspx. Coalition members can access the Handbook for Peer Assessors and Trusted Insiders for the Coalition Surge Test here: https://www.phe.gov/Preparedness/planning/hpp/Documents/cst-manual-020717.pdf.
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U.S. Department of Homeland Security, Federal Emergency Management Agency. (2018). IS-130.A: How to be an Exercise Evaluator.
This nearly three-hour course provides the foundation for HSEEP-based exercise evaluation concepts and practices.
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University of Arkansas. (2016). Access and Functional Needs: Injects for Use by Local Emergency Planning Personnel in Emergency Management Tabletops and Exercises.
This 24-page document provides disability-related materials for use by local emergency planning personal in emergency exercises and drills. They are based on listening sessions with people with intellectual and developmental disabilities, their family members, and emergency responders.
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  • Eileen Robichaud This link is broken. It no longer works. Please update the link.
    3/2/2023 1:37:26 PM
Yamaki, K., Mitchell, J., Coniglio, R., et al. (2014). Including People with Disabilities in Emergency Preparedness Activities. Illinois Department of Public Health.
This transcript is from a webinar designed to assist emergency preparedness professionals with including people with access and functional needs in emergency planning and exercises.
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Evaluation

* Federal Emergency Management Agency. (n.d.). HSEEP Policy and Guidance. (Accessed 9/22/2022.)
This website contains links to templates emergency planners can tailor for exercise program management, design and development, conduct, evaluation, and improvement planning. A link to exercise evaluation guides is also provided.
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Harvard T.H. Chan School of Public Health. (2014). Emergency Preparedness Exercise Evaluation Toolkit.
This online toolkit can help public health and healthcare agencies develop exercise evaluation forms for disaster exercise.
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Johns Hopkins University Evidence-based Practice Center. (2008). Tool for Evaluating Core Elements of Hospital Disaster Drills. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality.
The Center developed a set of evaluation modules and addendums for operationalized hospital disaster drills in 2004 and abridged it in 2008. The focus of this version is critical elements of drill evaluation that all hospitals should address as part of disaster preparedness.
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Guidance

Centers for Disease Control and Prevention. (2019). Public Health Emergency Preparedness and Response Capabilities.
These capability standards serve as benchmarks for communities across a variety of public health and medical domains. Because of the organization of the document across diverse emergency response functions many of the tasks and priorities can be translated directly into exercise objectives and points of evaluation.
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Centers for Medicare & Medicaid Services. (2017). Information to Assist Providers and Suppliers in Meeting the New Training and Testing Requirements of the Emergency Preparedness Requirements for Medicare & Medicaid Participating Providers and Suppliers Final Rule.
This memorandum provides information to assist providers and suppliers in meeting the Training and Testing requirements of the new Emergency Preparedness Final Rule that was published on September 16, 2016 (81 FR 63860) and became effective on November 15, 2016.
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Cheung, M., Vu, A., Varlese, D., et al. (2010). Hospital Preparedness Exercises: Guidebook. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality.
This guidebook shares requirements necessary for Federal funding and hospital accreditation as of 2009. Though it is somewhat outdated, the general concepts and references the guidebook contains may still assist healthcare emergency professionals in planning, carrying out, and evaluating exercises.
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Federal Emergency Management Agency. (2023). Inclusion, Diversity, Equity and Accessibility Guide Webinar Session 1. U.S. Department of Homeland Security.
This guide can help emergency managers ensure their exercises: are inclusive and diverse, incorporate community demographics, make information accessible, include underserved communities, and are tailored to meet the unique needs of specific segments of the whole community.
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Fruhwirth, K., Chambers, G., Shields, S., and Torres, R. (2012). Conducting Drills and Exercises: A Guide for Hospitals.
This guidebook (specific to Los Angeles County) includes general information on exercise design, creation and evaluation. Chapter 5 includes detailed guidance for scenario development, as well as numerous sample scenarios planners may find useful in developing their own exercises.
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Harvard University, Harvard T.H. Chan School of Public Health, Emergency Preparedness Research, Evaluation and Practice (EPREP). (2013). Public Health Emergency Preparedness Exercise Evaluation Toolkit Manual.
This toolkit manual can help exercise planners and evaluators prepare to conduct and evaluate emergency preparedness exercises. It includes sections on evaluation methodology and tools, exercise basics, and After Action Reports.
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National Association of County and City Health Officials. (n.d.). Guide for Incorporating Administrative Preparedness into Exercise. (Accessed 1/7/2020.)
This guide is a tool to assist in the integration of administrative preparedness concepts and activities into emergency preparedness drills and exercises. Though targeted to health departments, healthcare facilities may also find the information in the guide helpful.
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Office of the Assistant Secretary for Preparedness and Response. (2016). 2017-2022 Health Care Preparedness and Response Capabilities. U.S. Department of Health and Human Services.
This 70-page document describes the four capabilities that healthcare coalitions and individual healthcare facilities need to prepare for, respond to, and recover from emergencies. The capabilities are: foundation for healthcare and medical readiness; healthcare and medical response coordination; continuity of healthcare service delivery; and medical surge. For example, Capability 1, Objective 4 covers training and preparing the healthcare and medical workforce (Objective 4, Activities 3-5 also contain specific information about exercises within the HPP program) and Capability 3, Objective 7 is focused on coordinating healthcare delivery system recovery.
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Pennsylvania Health Care Coalition. (2023). Development of Exercises and After-Action Reports (DEX-AR).
The Development of Exercises and After-Action Reports (DEX-AR) Workshop is designed to provide a conduit for education and training through practical application of the FEMA Homeland Security Exercise and Evaluation Program. These materials are based on the Whole Community Approach, can strengthen the preparedness and resilience of coalition members and the community, and can help participants identify funding opportunities to strengthen plans, mitigate risks, and resolve gaps in preparedness efforts. (NOTE: Email askasprtracie@hhs.gov to request these files.)
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Supernaw, S. (2014). Challenges and Opportunities for Hospital Training and Exercises.
The webinar host identifies some of the regulatory and accreditation requirements for hospital emergency management and preparedness, and discusses some of the most common challenges to planning and executing emergency training and exercises in the hospital environment.
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U.S. Department of Homeland Security. (2017). Best Practices for Incorporating Social Media into Exercises: Social Media Working Group for Emergency Services and Disaster Management and DHS (Department of Homeland Security) S&T (Science and Technology) First Responders Group.
This report can help emergency planners learn more about best practices for integrating social media into exercises and explains why social media should be a part of all aspects of disaster planning. It also highlights recent examples and challenges associated with integrating social media into exercises and training.
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* Virginia Department of Health. (2018). Emergency Preparedness Exercise Planning for Healthcare Facilities.
This presentation reviews exercise planning basics to assist healthcare facilities with meeting the exercise requirements set forth in the 2016 Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness (EP) Rule, including examples for each step of the exercise planning process. It also includes a 90-minute tabletop exercise focused on an extreme thunderstorm scenario.
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Operations-Based Exercise Templates: Active Shooter

Hospital Association of Southern California. (2013). Active Shooter Drill Materials.
The Hospital Association of Southern California developed several documents that can help a healthcare facility plan for active shooter incidents and carry out an active shooter drill (e.g., checklists, participant releases, and pocket cards).
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Los Angeles County Emergency Medical Services Agency. (2017). Exercise Plan: Active Shooter/ Terrorist Scenario. Full Scale Exercise.
This customizable FSE template uses a state-wide terror attack as the scenario. It includes forms and checklists as appendices.
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Operations-Based Exercise Templates: Emerging/Infectious Disease

ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning for Frontline Facilities.
The speakers in this webinar share information on the development and use of exercise templates –specifically tailored for frontline facilities –to test readiness for highly pathogenic infectious patients.
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MESH Coalition. (2016). An Exercise in the Provision of Care for an Adult Patient under Investigation (PUI) for Ebola: A Patient Care Drill. (Free registration required.)
This simulation toolkit provides a situation overview, general information, simulation logistics, post-simulation and evaluation activities, and participant information and guidance along with appendices containing templates and forms for hospitals to test their established protocols for the provision of care to a patient with a suspect highly infectious disease. Multiple injects such as vomiting encourage testing a range of different procedures through the exercise.
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New York City Department of Health and Mental Hygiene. (n.d.). Mystery Patient Drill Toolkit. (Accessed 3/17/2021.)
This toolkit is intended for use by hospital emergency departments, and tests how long it takes for a potential patient with a highly infectious disease to be identified and for staff to begin exposure mitigation procedures; how long it takes for a patient to be transferred to an isolation room; and the capability of the facility to make notifications internally and to the health department. The Toolkit includes scenarios for Ebola Virus Disease, Middle East Respiratory Syndrome, and Measles, but may be modified to suit healthcare facilities of any nature and any type of disease outbreak.
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Ventura County Health Care Coalition. (2018). 2018 Ventura County Statewide Medical and Health Exercise Plan. This resource is the completed Exercise Plan for a full-scale exercise (FSE) conducted by the Ventura County Health Care Coalition to test response plans for an emerging infectious disease outbreak, using leptospirosis as the disease of concern
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World Health Organization. (2018). A Practical Guide For Developing and Conducting Simulation Exercises to Test and Validate Pandemic Influenza Preparedness Plans.
Though this guide was developed to support countries in their design and conduct of pandemic influenza exercises, the detailed guidance on scenario elements and exercise evaluation may be valuable to healthcare emergency planners at the state and local level, as well as in the healthcare facility setting.
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Operations-Based Exercise Templates: Evacuation

* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Health Care Coalition Surge Test Tool.
This training video provides an overview of how to use the HHS ASPR Health Care Coalition Surge Test Tool that tests ability to find beds for patients evacuating coalition hospitals.The tool can be found at https://www.phe.gov/Preparedness/planning/hpp/Pages/coaltion-tool.aspx. Coalition members can access the Handbook for Peer Assessors and Trusted Insiders for the Coalition Surge Test here: https://www.phe.gov/Preparedness/planning/hpp/Documents/cst-manual-020717.pdf.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Hospital Surge Evaluation Tool.
This tool can be used by hospital emergency planners, administrators, and other personnel to both assess and enhance their facility’s mass casualty surge plans. Emergency department and inpatient personnel must find appropriate space for waves of incoming virtual patients. It includes evaluation tools specific to emergency department triage and hospital incident command.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). HPP Coalition Surge Test Webinar.
This presentation describes the Coalition Surge Test, an annual grant requirement for healthcare coalitions (HCCs) that tests a simulated evacuation for 20% of the HCCs acute care bed capacity. Lessons learned and best practices from HCCs that participated during a pilot phase, and guidance for using exercise tools, are also reviewed including the role of HCC in coordination of evacuation activities. A link to the archived webinar is included. (For post-webinar questions and answers, access: https://files.asprtracie.hhs.gov/documents/aspr-tracie-ta-coalition-surge-test-webinar-qa.pdf.)
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Operations-Based Exercise Templates: General

California Hospital Association. (2016). Medical Surge Exercise Evaluation Guide Template.
This Exercise Evaluation Guide (EEG) template can be adapted for use by healthcare facilities when conducting medical surge exercises.
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Operations-Based Exercise Templates: Mass Casualty Incidents

Weston, B., Simpson, N., Hart, D., et al. (2015). Multiple Casualty Scenario from a Bomb/Blast Injury. MedEdPORTAL Publications. 2015;11:10065.
This article describes in detail the simulation plan for a blast-related mass casualty incident exercise targeted to emergency medicine residents. All of the associated materials may be downloaded for free. All the supporting materials are available for free download.
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Operations-Based Exercise Templates: Medical Countermeasures

Los Angeles County Department of Public Health. (2015). MCM Exercise Resource Page.
This webpage includes links to HSEEP-compliant exercise documents that were developed by the Los Angeles County Department of Public Health. This series of exercises concluded with full-scale exercises of Medical Countermeasure Distribution and Dispensing in November 2015.
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Massachusetts Office of Health and Human Services. (2009). EDS Full Scale Exercise (FSE).
This webpage contains links to resources that comprise of a toolkit on developing, running, and evaluating an Emergency Dispensing Site. The toolkit includes instructions, a Master Scenario Events List, evaluation guides, and other related documents that can be tailored by healthcare exercise planners.
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Operations-Based Exercise Templates: Natural Disaster

* Primary Care Emergency Preparedness Network. (n.d.). Community Health Center Coastal Storm Exercise Plan. (Accessed 1/7/2020.) New York City Department of Health and Mental Hygiene.
This HSEEP-compliant full-scale/functional exercise planning tool can help planners develop a hurricane-specific operations-based exercise for community health centers. It may be referenced by other healthcare facilities for developing similar exercises.
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Santa Barbara County Public Health Department. (2018). 2018 Extended Power Outage Exercise.
This webpage includes links to Santa Barbara County’s exercise materials, including objectives and exercise forms, for the annual statewide full-scale exercise held in California. The scenario for the 2018 exercise was an extended power outage with evacuations.
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* Shakeout. (n.d.). ShakeOut Exercise Manual For Healthcare Organizations. (Accessed 1/7/2020.)
This document provides guidance for healthcare facilities that wish to participate in a ShakeOut (earthquake) exercise in their community. It includes checklists to guide planning for a drill, a tabletop exercise, and a functional exercise.
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South Carolina Emergency Management Division. (2016). 2016 South Carolina Full Scale Exercise—“Shaken, Not Stirred”.
This exercise plan serves as a template for a full scale earthquake exercise.
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Operations-Based Exercise Templates: Pediatric

Illinois Emergency Medical Services for Children. (2016). Addressing the Needs of Children in Disaster Preparedness Exercises, 2nd Edition.
This document includes guidance and tools to assist planners with including pediatric-focused scenarios and considerations in their disaster preparedness exercises. It includes discussion of exercise components by setting; how to incorporate children into disaster exercises; and sample exercise scenarios.
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Plans, Tools, and Templates: General

ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning for Health Care Coalitions.
The speakers in this webinar discussed exercise templates designed to help manage patients with highly pathogenic infectious diseases; explained how exercises support ASPR's regional, tiered approach; and shared their experiences planning and executing exercises for Ebola and other special pathogens.
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ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning for Regional Transport Webinar.
The speakers shared information on exercise templates (specifically tailored for regional transport) to test readiness for highly pathogenic infectious patients; explained how exercises support ASPR’s regional, tiered approach; and discussed tips from three jurisdictions on how to exercise plans.
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* California Association of Health Facilities. (n.d.). Disaster Preparedness Program Exercises and Drills. (Accessed 1/7/2020.)
This webpage provides a number of resources for healthcare facilities (including long-term care facilities) regarding drills, tabletop exercises, after action report and improvement plan templates, and training resources. It was developed by CAHF to assist healthcare facilities to comply with the new CMS EP Rule.
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Cheung, M., Vu, A-T., Varlese D., et al. (2010). Hospital Preparedness Exercises Pocket Guide. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality.
The quick reference guide summarizes the Hospital Preparedness Exercises Guidebook and can assist with evacuation planning.
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* Federal Emergency Management Agency. (n.d.). After-Action Report/Improvement Plan (AAR-IP) Template. (Accessed 1/15/2020.)
Evaluators can use this template to monitor and incorporate corrective actions on a continual basis to improve the preparedness and planning process.
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* Federal Emergency Management Agency. (n.d.). HSEEP Policy and Guidance. (Accessed 9/22/2022.)
This website contains links to templates emergency planners can tailor for exercise program management, design and development, conduct, evaluation, and improvement planning. A link to exercise evaluation guides is also provided.
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Harvard T.H. Chan School of Public Health. (2019). Emergency Preparedness Research, Evaluation & Practice (EPREP): Drills and Exercises.
Public, private, and non-governmental organizations can use the resources on this page to prepare for and respond to emergencies of all types. Resources, including an exercise evaluation toolkit, are focused on design and facilitation, evaluation, exercise resources, and hospital-specific exercises.
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New York State Health Emergency Preparedness Coalition. (n.d.). Homeland Security Exercise and Evaluation Program (HSEEP). (Accessed 1/7/2020.)
This webpage includes links specific to the HSEEP program, as well as many HSEEP-compliant customizable templates for designing, conducting, and evaluating exercises.
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Northwest Health Services Coalition. (2019). Exercise/Drill Materials.
This web page includes links to a variety of templates (e.g., after action reports, drills/tabletop examples, scenarios, and evaluation guides) healthcare facilities can tailor to suit their needs.
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Research

Ali, M. and Williams, M. (2019). Correction to No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015-2016. Journal of Community Health. 44(2): 387–394.
Three rounds of mystery patient drills simulating either influenza-like illness measles were conducted at 41 community health centers in New York City from April 2015 through December 2016. Through qualitative analysis, several strengths (e.g., established protocols, effective communication) and challenges (e.g., hand hygiene, explaining isolation rationale) were identified. The authors note that these types of drills can serve as helpful emergency preparedness tools for community health centers and provide examples of key evaluation components.
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Bentley, S., Iavicoli, L., Boehm, L., et al. (2019). A Simulated Mass Casualty Incident Triage Exercise: SimWars. MedEdPORTAL Publications. 2015;11:10065.
This article describes a multipatient simulation exercise that requires hospital medical providers to rapidly classify and disposition mass casualty incident (MCI) patients, using a format that allows two teams to participate in identical simulations coupled with active audience observation, followed by facilitated group discussion. All of the participants reported good/excellent ability to accomplish MCI initial triage and patient disposition after the exercise.
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Breslin, P., McGowan, C., Pecheux, B. and Sudol, R. (2007). Serious Gaming: Advanced Computer Simulation Games Help to Transform Healthcare and Disaster Preparedness. Health Management Technology. 28(10):14, 16-17.
This article describes a game-based training environment that incorporates multiple, adjustable, variables such as numbers of participants and victims, skill level of first responders and relative effectiveness of the measures taken. The key innovation underlying the simulation is a capability called Game Analysis, which captures and analyzes all of the data generated during the play of a game.
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Fowkes, V., Blossom, J., Sandrock, C., et al. (2010). Exercises in Emergency Preparedness for Health Professionals in Community Clinics. Journal of Community Health. 35(5):512-518.
The authors discuss the progress made by 90 community practice sites across California following their completion of multidisciplinary tabletop exercises. The discussion reviews planning and scheduling challenges, and strategies that helped overcome them.
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Gillett, B., Silverberg, M., Roblin, P., et al. (2011). Computer-Facilitated Assessment of Disaster Preparedness for Remote Hospitals in a Long-Distance, Virtual Tabletop Drill Model. (Free registration required.) Prehospital Disaster Medicine. 26(3):230-3.
The authors developed and tested an Internet-based software tool to assess disaster preparedness for remote hospitals using a long-distance, virtual, tabletop drill. Results were positive, and indicated that weekly reinforcement contributed to strong compliance with the study.
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Pate, A., Bratberg, J., Robertson, C. et al. (2016). Evaluation of a Tabletop Emergency Preparedness Exercise for Pharmacy Students. American Journal of Pharmaceutical Education.
The purpose of this research study was to demonstrate the application and observe the effects of an emergency preparedness laboratory activity (e.g. discussion based tabletop exercise) on second-year pharmacy students. The focus of the activity was for students to create and examine emergency response plans within small groups.
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Savoia, E., Agboola, F., and Biddinger, P. (2014). A Conceptual Framework to Measure Systems’ Performance during Emergency Preparedness Exercises. International Journal of Environmental Research and Public Health. 11(9): 9712-9722.
The authors spent six years designing and reviewing over 70 public health emergency exercises and used their findings to create a conceptual framework that lists the essential elements necessary to scientifically measure performance. They list two main limitations that contribute to this field’s delay in progression: fear of public criticism often precludes jurisdictions from sharing exercise results and evaluations are often carried out in a qualitative versus quantitative process.
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Skryabina, E., Reedy, G., Amlot, R., et al. (2017). What is The Value of Health Emergency Preparedness Exercises? A Scoping Review Study. International Journal of Disaster Risk Reduction. 21: 274-283.
The authors conducted a literature review on the effects of exercises on emergency response within the healthcare community. They found that exercises were effective at “improving participants’ knowledge of emergency activities, policies and procedures and improving overall competence and confidence,” and “improved perceptions of preparedness, and improved understanding of individual roles, and roles of partners.” They note that it is unclear if these improvements positively impact actual emergency response.
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Agencies and Organizations

California Department of Public Health. California Statewide Medical & Health Exercise.
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Centers for Disease Control and Prevention. Public Health Preparedness Capabilities: National Standards for State and Local Planning.
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Federal Emergency Management Agency. Center for Domestic Preparedness.
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Federal Emergency Management Agency. Emergency Planning Exercises.
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Harvard T.H. Chan School of Public Health. Emergency Preparedness Research, Evaluation & Practice (EPREP).
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This ASPR TRACIE Topic Collection was comprehensively refreshed and reviewed in January 2020 by the following subject matter experts (listed alphabetically): Joseph Albanese, PhD, Connecticut HCC Response Coordinator, Radiation Biodosimetrist, Center for Emergency Preparedness & Disaster Response; Eric R. Alberts, CEM, FPEM, FPEM-HC, CHPP, CHEP, SEM, Corporate Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Jim Bolen, MS, Planning Section Chief, Butler County / State of Ohio AHIMT; Dianna Bryant, PhD, CIH, CSP, Director, Institute for Rural Emergency Management, Associate Professor Crisis and Disaster Management, University of Central Missouri; Julie Bulson, DNP, MPA, RN, NE-BC, Director, Business Assurance, Spectrum Health; Craig DeAtley, Director, Institute for Public Health Emergency Readiness, MedStar Washington Hospital Center; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Mark Jarrett, MD, MBA, MS, SVP & Chief Quality Officer, Deputy Chief Medical Officer, Northwell Health; James L. Paturas, DHSc, CEM, EMTP, Director, Center for Emergency Preparedness & Disaster Response; Ann Potter, RN, CEM, CHEP, Institute for Public Health Emergency Readiness; Christopher Riccardi, CHSP, CHEP, Manager, Business Continuity Program, CHOC Children’s, Orange, CA; and L. Corey Sloan, EdD, MS, MA, EMT-P, Deputy Chief of EMS and Rescue, NTA EMS Rescue, Deputy Emergency Manager, Harrison County (MO) EMA.

It was comprehensively reviewed in August 2016 by: John Hick, MD, HHS ASPR and Hennepin County Medical Center; Mark P. Jarrett, MD, MBA, MS, SVP & Chief Quality Officer, Associate Chief Medical Officer, Northwell Health, Professor of Medicine, Hofstra Northwell School of Medicine; Jodi Keller, RN, Associate Director of Healthcare System Emergency Preparedness, Central Ohio Trauma System; Brad Learn, Emergency Preparedness Coordinator, Kentucky Hospital Association; Ann Potter, RN, CHEP, Institute for Public Health Emergency Readiness, Medstar Washington Hospital Center; Christopher Riccardi, CHSP, CHEP, Emergency Preparedness Program Manager, Providence Health and Services; Mary Russell, EdD MSN, Emergency Services, Boca Raton Regional Hospital; and the Yale New Haven Health System Center for Emergency Preparedness and Disaster Response.

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