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Workplace Audit/Evaluation Report:Mass-Casualty Exercise/Real World Analysis
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Workplace Audit/Evaluation Report
Mass-Casualty Exercise/Real World Analysis
This in-depth mass-casualty exercise was created by Earl Williams, safety coordinator at BroMenn Healthcare in Illinois, to help track and improve performance. It is broken into categories for victim management, victim transport, incident communication, incident command, incident support, and drill planning. Areas are left blank so supervisors may include their own observations that could be incorporated into future versions of the survey. Once scores are totaled, Williams has a better grasp of performance as well as the quality of the drill and whether it needs to be refined.
Location:_______________________________________________________________________
Date:____________________________________________Day (S /M /T /W/ R/ F/ A) Shift (Day/Evening)
Notification time:__________________________Hours All Clear Time:_______________________Hours
Patient count:_____________________________Victim count:___________________________
Number ET/S staff assigned:___________________ Number ET/S staff present:___________________
Event type:_________________________________________________________________________
Weather: Temperature outside: less than 40 degrees F40-60 degrees FMore than 60 degrees F
Relative humidity: less than 30%30-50%More than 50%
Rain/MistySnowSleet/IceFogWindyClearCloudy
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Indicator |
Time |
Worst (0-1) |
Partial (2-3) |
Best (4-5) |
Total |
| A |
Victim Management |
| A.1 |
Did victim triage start immediately upon
victims arrival? |
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| A.2 |
Were victims identified and registered |
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| A.3 |
Were victims left alone? |
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| A.4 |
Was ET/S ready to receive victims? |
less than
30 minutes |
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| A.5 |
Were victims tagged prior to arrival? |
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| A.6 |
Were any victims transferred out? |
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| A.7 |
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| A.8 |
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| A.9 |
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| A.10 |
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Indicator |
Time |
Worst (0-1) |
Partial (2-3) |
Best (4-5) |
Total |
| B |
Victim Transport |
| B.1 |
Were there at least four transporters
(hospitality) on hand? |
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| B.2 |
Were there sufficient numbers of gurneys,
etc., on hand? |
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| B.3 |
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| B.4 |
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| B.5 |
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| B.6 |
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Indicator |
Time |
Worst (0-1) |
Partial (2-3) |
Best (4-5) |
Total |
| C |
Incident Communication |
| C.1 |
Did ET/S staff respond upon
notification of mass casualty? |
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| C.2 |
Was a public address announcement
made for notification? |
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| C.3 |
Were key areas notified? |
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| C.4 |
Was BMG Offices notified? |
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| C.5 |
Was the emergency notification verified? |
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| C.6 |
Did personnel hear and understand
what the code meant? |
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| C.7 |
Were staff members kept informed
of emergency status? |
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| C.8 |
Was unit call-in performed? |
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| C.9 |
Were additional physicians
called in? [may be stimulated] |
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| C.10 |
Was surgery call-in performed? |
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| C.11 |
Did medical coordinator and/or
clinical coordinator contact ESDA? |
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| C.12 |
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| C.13 |
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| C.14 |
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| C.15 |
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| C.16 |
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Indicator |
Time |
Worst (0-1) |
Partial (2-3) |
Best (4-5) |
Total |
| D |
Incident Command |
| D.1 |
Was a command center established
upon notification? |
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| D.2 |
Was this a Level (1)?
[no additional help needed] |
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| D.3 |
Was this a Level (2)?
[key area additional help needed] |
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| D.4 |
Was this a Level (3)?
[all medical center employees needed] |
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| D.5 |
Was arrangement made to
accommodate the news media? |
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| D.6 |
Was a temporary morgue designated? |
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| D.7 |
Was there a sense of confusion? |
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| D.8 |
Was documentation of activities logged? |
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| D.9 |
Were rumors adequately controlled? |
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| D.10 |
Were there plans to destress staff? |
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| D.11 |
Was nursing pool established? |
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| D.12 |
Could lives have been saved? |
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| D.13 |
Was someone in command? |
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| D.14 |
Was a command team formed? |
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| D.15 |
Was coordination effective? |
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| D.16 |
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| D.17 |
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Indicator |
Time |
Worst (0-1) |
Partial (2-3) |
Best (4-5) |
Total |
| E |
Incident Support |
| E.1 |
Did security staff respond to the emergency
room area? |
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| E.2 |
Did ET/S request and get additional
clinicians? |
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| E.3 |
Did blood bank respond? |
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| E.4 |
Did laboratory personnel respond? |
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| E.5 |
Were all hospital entrances, doors
locked and/or monitored? |
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| E.6 |
Was vehicle traffic controlled at ET/S |
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| E.7 |
Did staff know their roles during
this emergency? |
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| E.8 |
Was PPE used correctly in ET/S during
the emergency at all times? |
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| E.9 |
Was equipment used correctly? |
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| E.10 |
Was there adequate supplies on hand? |
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| E.11 |
Was access/egress from
hospital controlled? |
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| E.12 |
Was ICU available to receive victims? |
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| E.13 |
Was out patient open for victims? |
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| E.14 |
Was mental health available? |
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| E.15 |
Was employee support pool established? |
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| E.16 |
Were disaster drill signs posted? |
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| E.17 |
Were PAR levels checked? |
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| E.18 |
Was patient registration at triage? (X2)
[properly marked with green arm bands] |
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| E.19 |
Was pharmacy representative
at triage? (X1) |
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| E.20 |
Was physical medicine and/or rehabilitation
at triage? (X2) |
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| E.21 |
Was radiology at triage? (X1) |
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| E.22 |
Was social services/pastoral care
representative at surgery waiting? |
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| E.23 |
Did security guard the morgue? |
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| E.24 |
Were door monitors on doors? |
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| E.25 |
Was there a parking area established
for the news media? |
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| E.26 |
Adequte staffing? |
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| E.27 |
Equipment function correctly? |
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| E.28 |
Equipment and supplies adequate? |
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| E.29 |
Was a cardiopulmonary representative
at triage? (X2) |
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| E.30 |
Were portable suction machines
at triage? (X2) |
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| E.31 |
Was community relations representative
in the press area? |
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| E.32 |
Was community relations representative
in the triage area? (X1) |
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| E.33 |
Did facilities deliver disaster carts
to the triage area? |
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| E.34 |
Did facilities staff the elevators? |
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| E.35 |
Did facilities provide a driver for supplies? |
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| E.36 |
Did hospitality provide special cleaning
crew to triage? |
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| E.37 |
Did laboratory inventory blood supplies? |
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| E.38 |
Did medical records personnel respond
to victim discharge area? |
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| E.39 |
Did patient accounts respond to the
Atrium area? (X2) |
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| E.40 |
Did patient registration respond
to the switchboard operator? |
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| E.41 |
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| E.42 |
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| |
Indicator |
Time |
Worst (0-1) |
Partial (2-3) |
Best (4-5) |
Total |
| F |
Drill Planning |
| F.1 |
Were there special ID badges
for evaluators/observers? |
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| F.2 |
Was nutrition available for
drill participants? |
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| F.3 |
Did scenario adequately test personnel,
equipment, supplies, etc.? |
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| F.4 |
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| F.5 |
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| F.6 |
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| F.7 |
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All item scores of 3 or below require action and/or a Plan for Improvement (PFI). PFIs and other documents should be attached and forwarded to the safety office within 72 hours.
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