Maryland Department of Health
Office of Preparedness and Response

Programs: Training and Exercises

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Training and exercises play a large role at the Office of Preparedness and Response (OP&R). We prioritize workforce development and our staff is required to take National Incident Management System (NIMS) and Incident Command System (ICS) courses. The Office of Preparedness and Response also regularly plans and participates in various exercises with preparedness partners from accross the state. These realistic, but risk-free exercises provide the opportunity to practice prevention, response, and recovery capabilities. 

For example, OP&R, the Maryland Department of Emergency Management (MDEM), Maryland Department of the Environment (MDE) and other state partners participate each year in an exercise to assess Maryland's ability to respond to an emergency at the Calvert Cliffs or Peach Bottom nuclear power plant facilities. 

OP&R also holds regular tabletop exercises (TTXs). These are discussion-based sessions where people meet to talk about their roles and responses to a simulated emergency. They can be used to assess plans, policies, and procedures and to identify areas for improvement. TTXs can cover a variety of topics including: chemical hazards, hospital preparedness, cyber attacks, extreme heat, pandemics and more.

Holding regular exercises like these ensures that Maryland is prepared and ready for any future health emergencies that could​ affect the citizens of our state.​​


​Exercise Development Process

Training and Exercise Planning Workshop (TEPW)

 

A Training and Exercise Planning Workshop establishes the overall strategy and structure of an exercise and training program. At the Office of Preparedness and Response, we engage our Local Health Departments, Health Care/Hospital Preparedness Partners (HPP), and other state agencies to determine exercise priorities. Those ideas are used along with the exercise requirements that come with our grant funding from the Centers for Disease Control and Prevention (CDC) and Office of the Assistant Secretary for Preparedness and Response (ASPR) to develop a Multiyear Training and Exercise Plan (MYTEP), which covers five years.

In general, a Mul​tiyear Training and Exercise Plan should identify priorities and then structure training and exercises to follow a logical and progressive arc. Trainings, workshops, seminars, discussion-based exercises (tabletop exercises), and progressively more complex operations-based exercises (drills, functional exercises, full scale exercises) are developed with the outcomes and lessons-learned at each step informing the development of the next exercise.​

Concepts and Objectives Meeting (C&O)

 

Once exercise priorities have been established, an exercise planning team consisting of people from participating organizations and other stakeholders meets to determine the scope and objectives for the exercise. The planning team may also discuss basic details of the exercise in this meeting, such as where and when to hold the exercise and what resources may be needed. Depending on the scale of the exercise, this meeting may be combined with the Initial Planning Meeting.​​

Developing Exercise Objectives

 

​Based on input from officials and stakeholders, the exercise planning team selects program priorities on which to focus the exercise. These priorities inform the development of exercise objectives, which are distinct outcomes that an organization wishes to achieve during an exercise. Objectives should incorporate guidance from officials, exercise participant’s plans and procedures, operating environment, and desired outcomes. The planning team selects a reasonable number of specific, measurable, achievable, relevant, and time-bound objectives to facilitate effective scenario design, exercise conduct, and evaluation. ​​​​​​


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The planning team aligns each exercise objective to one or more core capabilities.  The figure below shows the relationship between exercise program priorities, exercise objectives, and core capabilities. Aligning objectives to a common set of capabilities enables:

  • ​Systematic tracking of progress over the course of exercise programs and/or cycles;​​

  • Standardized exercise data collection to inform preparedness assessments; and

  • Fulfillment of grant or funding-specific reporting requirements. 

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Exercise Scenario Development

 

A scenario is an outline or model of the simulated sequence of events for the exercise. It can be written as a narrative or depicted by an event timeline.

For discussion-based exercises, a scenario provides the backdrop that drives participant discussion, and is contained in a Situation Manual. For operations-based exercises, a scenario provides background information about the incident catalyst(s) of the exercise. Exercise planners should select and develop scenarios that enable an exercise to assess objectives and core capabilities. All scenarios should be realistic, plausible, and challenging. However, designers must ensure the scenario is not so complicated that it overwhelms players.

A scenario consists of three basic elements:

  1. The general context or comprehensive story;

  2. The required conditions that will allow players to demonstrate proficiency and competency in conducting critical tasks, demonstrating core capabilities, and meeting objectives; and

  3. The technical details necessary to accurately depict scenario conditions and events.

The exercise planning team ensures that the design effort is not characterized by a fixation on scenario development. Rather, the scenario facilitates assessment of exercise objectives and core capabilities. Because of this, exercise planners should refrain from developing the scenario until after the scope and objectives of the exercise have been clearly defined. Scenarios should avoid any sensitivity that may arise, such as the use of real names of terrorist groups or sensitive venues.​


Threat or Hazard Selection

 

​The first step in designing a scenario is determining the type of threat or hazard on which the exercise will focus. Each type of emergency has its own strengths and weaknesses when it comes to evaluating different aspects of prevention, protection, mitigation, response, and recovery. The exercise planning team should choose a threat or hazard that best assesses the objectives and core capabilities on which the exercise will focus. The identification of this threat or hazard scenario should also be based on the organization’s threat/hazard identification and risk assessment. Developing and maintaining these risk analyses is an essential component of the National Preparedness System, as they enable organizations to identify potential events that would stress their core preparedness capabilities.​

Initial Planning Meeting (IPM)

 

​The purpose of an Initial Planning Meeting is to continue developing the scope and objectives of an exercise, to identify exercise design requirements and conditions, participant extent of play, and scenario variables based on the plans, procedures, and policies that are to be tested. This meeting is also used to begin developing the exercise documents, such as the Exercise Plan and Situation Manual.​

Midterm Planning Meeting (MPM)

 

​The Midterm Planning Meeting’s primary purpose is to discuss organization and staffing concepts, scenario and timeline development, scheduling, logistics, and administrative requirements.  Additionally, the draft documentation developed from the Initial Planning Meeting is reviewed here. Depending on the scope of the exercise, the planning requirements, and the time between this meeting and the exercise, the planning team may also begin developing the Master Scenario Events List.  Development of the Master Scenario Events List can also take place during a dedicated Master Scenario Events List meeting that would occur between the Midterm Planning Meeting and the Final Planning Meeting.

The Midterm Planning Meeting is generally the cut-off for all major changes to the exercise plan so that finalized versions of all documents can be developed. All remaining exercise documentation (Controller/Evaluator Handbook, Exercise Evaluation Guides, presentation materials, etc.) should be in development by the Midterm Planning Meeting so they can be reviewed and finalized at the Final Planning Meeting.

Final Planning Meeting (FPM)

 
At the Final Planning Meeting, the exercise team discusses the final draft of all exercise documentation, finalizes all logistical requirements, resolves any outstanding issues, and reviews all details before the beginning of the exercise. No major changes should be made at the Final Planning Meeting. After the Final Planning Meeting, the planning team sends all documents for printing and prepares to conduct the exercise by doing any advance setup or logistics work that is needed, preparing the controllers and evaluators, and briefing the players if needed.​​

Exercise Wrap-Up

 

​After the exercise has been conducted, wrap-up activities collect additional data to support effective evaluation and improvement planning.

Debriefing: Immediately following the exercise, a short debriefing should be conducted with the exercise planning team members to ascertain their level of satisfaction with the exercise, discuss any issues or concerns, and propose improvements.

Player Hot Wash: A Hot Wash provides an opportunity for exercise participants to discuss exercise strengths and areas for improvement immediately following the conduct of an exercise. The Hot Wash should be led by an experienced facilitator who can ensure that the discussion remains brief and constructive. The information gathered during a Hot Wash can be used during the After Action Report and Improvement Planning (AAR/IP) process, and exercise suggestions can be used to improve future exercises. Hot Washes also provide opportunities to distribute Participant Feedback Forms which, when completed by players, can be used to help generate the After Action Report and Improvement Planning.

Controller/Evaluator (C/E) Debriefing: The Controller/Evaluator Debriefing provides a forum for functional area controllers and evaluators to review the exercise. The exercise planning team leader facilitates this debriefing, which provides each controller and evaluator with an opportunity to provide an overview of the functional area they observed and to discuss both strengths and areas for improvement. Debriefing results are captured and may be included in the After Action Report and Improvement Planning.

After Action Report (AAR)

 
The After Action Report is the document that summarizes key information related to evaluation. The main focus of the After Action Report is the analysis of core capabilities. Generally, After Action Reports also include basic exercise information, such as the exercise name, type of exercise, dates, location, participating organizations, mission area(s), specific threat or hazard, a brief scenario description, and the name of the exercise sponsor and Point of Contact.

The After Action Report should include an overview of performance related to each exercise objective and associated core capabilities, while highlighting strengths and areas for improvement. Therefore, evaluators should review their evaluation notes and documentation to identify the strengths and areas for improvement relevant to the participating organizations’ ability to meet exercise objectives and demonstrate core capabilities.

Upon completion of the first draft of the After Action Report, it should be provided to the participating organizations for review. Partners can help to determine which areas for improvement require further action and to identify corrective actions to bring areas for improvement to resolution and determine the organization with responsibility for those actions.​

After Action Meeting (AAM)

 
After the draft of the After Action Report has been distributed to participating organizations, an After Action Meeting is conducted to review any changes that participants have proposed. During this meeting, the participants work to reach consensus on strengths, areas for improvement, and corrective actions. After Action Meeting (AAM) participants also develop concrete deadlines for implementation of corrective actions and identify specific corrective action owners/assignees. Participant organizations are responsible for developing implementation processes and timelines, and keeping their elected and appointed officials informed of the implementation status.

Corrective Action Tracking and Implementation

 

Once all corrective actions have been consolidated in the final Improvement Planning, the Improvement Planning may be included as an appendix to the After Action Report. The After Action Report and Improvement Planning is then considered final, and may be distributed to exercise planners, participants, and other preparedness stakeholders as appropriate.

Corrective actions captured in the After Action R​​eport and Improvement Planning should be tracked and continually reported on until completion. Organizations should assign points of contact responsible for tracking and reporting on their progress in implementing corrective actions. By tracking corrective actions to completion, preparedness stakeholders are able to demonstrate that exercises have yielded tangible improvements in preparedness. Stakeholders should a​​​lso ensure there is a system in place to validate previous corrective actions that have been successfully implemented. These efforts should be considered part of a wider continuous improvement process that applies prior to, during, and after an exercise is completed.​​​​​​

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