South Dakota Statewide Terrorism Exercise Finds Experience the Best Teacher

The best way to learn from experience is to have the experience yourself. That's what South Dakota Department of Health (SDDOH) decision-makers found when they ran their first statewide terrorism preparedness exercise in 2006 -- and what they expect to find in future exercises.

During this exercise they tested in real-time the complex communications necessary in a disaster and learned that a streamlined analysis process is critical when receiving information. They also learned that successful preparedness means having an adequately staffed, equipped and dedicated Emergency Operations Center at the hospital, local, regional and state level.

"These essential lessons benefit public health officials in their initial exercises," said Steve Wood, vice-president of consulting and professional services for Global Secure who worked with SDDOH on the exercises. "Public health officials have become more sophisticated in developing emergency response plans, but truly testing the operational capabilities of those plans teaches lessons that no classroom can."

SDDOH officials believed it would be better to learn those lessons during an exercise rather than when a real disaster strikes. More than 300 individuals from 64 of South Dakota's 67 hospitals participated in the exercise in which fictitious concert-goers exposed to plague began jamming hospital emergency rooms approximately 48 hours after exposure.

"The beauty of this exercise was that it comprehensively tested every possible situation that would arise in this type of emergency," said LaJean Volmer, hospital preparedness coordinator with the South Dakota Department of Health. "The scenario was realistic and aggressive and had the public health department in the lead role," she added.

This exercise marked the first time hospitals from across the state, as well as other public health and local emergency management agencies, collectively responded to a mock bioterrorism disaster drill. The program tested response systems and communications between hospitals, local emergency management, and public health officials at the State Department of Health.

Hospitals could participate at the level that was appropriate to their particular site. Some activated full-scale Emergency Operations Centers, even bringing in sample patients. Some hospitals made calls to the sheriff and coroner's office as part of the drill. Others used the exercise to test their infection control procedures and internal pharmaceutical capabilities to provide treatment to patients as well as prophylaxis care for staff.

"The high percentage of participation, 97 percent of the state's hospitals, was outstanding," Volmer added. "And judging from the overwhelmingly positive feedback we received, everyone learned and got value out of this."

With less than five weeks to prepare, Global Secure worked with an Exercise Development team comprised of South Dakota Department of Health and hospital personnel to create the exercise. Exercise goals were to implement the Incident Command Structure (ICS) in each hospital, local emergency management agency and at the state Department of Health, to test communications between hospitals, local emergency management and the State, and to enable hospitals to test their internal plans and processes for responding to a contagious, bioterrorism crisis.

"Because this was the first statewide bioterrorism preparedness exercise conducted in South Dakota, we knew we needed to partner with an expert with extensive experience," said Volmer. "Global Secure was the clear choice. They are experts in medical and public health exercises, and have the experience we sought in conducting exercises involving hospitals and public health entities."

As part of its exercise services package, Global Secure facilitates a post-exercise "Super Conference" soon after the exercise. "Not all exercise providers offer such a rigorous evaluation, analysis, and strategic planning service, and it was a huge benefit by giving us some very concrete objectives to put into our roadmap next steps," said Volmer.

The Super Conference provided a forum for reviewing participant feedback, discussing findings and making recommendations, and leading hospital and public health officials through a process of prioritizing recommendations, assigning tasks and identifying the resources needed.