ShakeOut Exercise Manual

For Hospitals

Are You Ready to ShakeOut?

Major earthquakes can cause unprecedented catastrophes. With earthquakes as an inevitable part of
our future, hospitals should make plans and take actions to ensure that disasters do not become
catastrophes. What we do now, will determine what our lives will be like afterwards. With this in mind,
the Earthquake Country Alliance (www.earthquakecountry.org) created the ShakeOut, an earthquake
drill and preparedness activity in which everyone can participate. To register as a ShakeOut
participant, go to our website (www.shakeout.org) and sign up for the drill in your area. In particular,
hospitals of all sizes can use the drill to get their employees, volunteers, partners, and even their
patients, involved and prepared for a big earthquake. Furthermore, the level of your staffs’ own
personal and family preparedness will be key to their availability to support your organization’s
response and recovery efforts after a disaster.

Although they were created for ShakeOut drill events across the nation the instructions on the following
pages can be used or adapted for earthquake drills anywhere and anytime. The following drill and
exercise guidelines are designed for hospitals and other organizations and their personnel where each
drill uses the general earthquake response of Drop, Cover, and Hold On (www.dropcoverholdon.org) as
its foundation. To be flexible, the following pages provide three options for drill designs ranging from
very simple (Level 1) to advanced (Level 3), each with steps to be taken before, during, and after the
drill or exercise. Going forward, your organization can customize and build one that suits your specific
needs.

Drills and Exercises for Hospitals

Level 1 – Simple: Drop, Cover, and Hold On Drill....................................................................Page 2

This drill uses simple steps to inform all employees how to perform Drop, Cover, and Hold On -
a quake-safe action designed to protect lives from falling furniture and flying objects than can
become projectiles during ground shaking.

Level 2 – Intermediate: Decision-Making Tabletop Exercise..................................................Page 3

This decision-making exercise is designed to have key staff and leaders think through more
complex issues related to operations in the immediate aftermath of this earthquake,
then afterwards to review and discuss what worked or what did not, in order to make changes
for the next exercise or actual earthquake.

Level 3 – Advanced: Hospital Functional Exercise .................................................................Page 6

This operations-based exercise tests command and control during a major earthquake including
emergency response and/or recovery duties in your Emergency Operations Plan. The exercise
incorporates simulated incidents, decision-making, and policies tested, and then a review afterwards to
discuss what worked or what did not in order to make changes for the next earthquake or exercise.

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Level 1 – Simple: Drop, Cover, and Hold On Drill

This drill uses simple steps to inform all employees how to perform Drop, Cover, and Hold On – a
quake-safe action designed to protect lives from falling furniture and flying objects than can become
projectiles during ground shaking.

BEFORE the Drill

1. If you will participate in a ShakeOut drill, register your facility as an official participant at
www.ShakeOut.org (make sure to register in your state or region).
2. Inform your employees/staff and volunteers regarding:
□ The date and time of your drill.
□ How to correctly perform Drop, Cover, and Hold On, wherever they are.
□ Your expectations for their participation (i.e. Drop/Cover/Hold On, gather at a central
location for a head count, post-drill discussions).
□ If your drill is part of a ShakeOut, encourage employees, volunteers, etc. to invite friends,
families, and neighbors to register at www.ShakeOut.org, in their region, so they participate
as well and receive information directly.
3. Inform patients and visitors of the drill.
4. (Optional) Download realistic sound effects and safety information to play during your drill by
downloading recordings from www.ShakeOut.org/resources.
5. Review Hospital Incident Command System Earthquake Incident Planning Guide and Incident
Response Guide available at www.emsa.ca.gov/hics/hics.asp, www.hicscenter.org and
www.calhospitalprepare.org.
6. If your facility participated in a prior ShakeOut Drill or Exercise, review past After Action Reports
and Improvement Plans.

DURING the Drill

1. Via the public announcement (PA) system, email, cell phone/text message, or verbal direction:
□ Announce that the earthquake drill has begun and to Drop, Cover, and Hold On.
□ (Optional) Play the audio recording (see above) on your PA or, alternatively, play it on a
computer in each office.
□ Suggest that while down on the floor, employees look around at what would be falling on
them in a real earthquake. These items should be secured or moved after the drill.
2. After at least one minute, announce that the shaking is over and that employees can stand up
again. Thank them for participating.
3. Encourage employees to discuss their experiences with one another.

AFTER the Drill

1. Ask for feedback on how the drill went.

2. Schedule the next drill for one year later (or sooner if employees need to practice).
3. Share photos and stories at www.ShakeOut.org
4. Review “7 Steps to an Earthquake Resilient Business” for additional ideas.

5. Encourage employees to prepare at home using the 7 Steps to Safety from “Putting Down Roots in
Earthquake Country” (see www.earthquakecountry.org).

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Level 2 – Intermediate: Tabletop Exercise

This exercise is a discussion-based exercise for decision-makers to consider how the earthquake
would impact your facility and identify plans and policies and procedures to be used during the event.
In addition to the Tabletop Exercise, it also includes the brief Level 1 focus drill in terms of the entire
facility employee participation in a Drop, Cover, and Hold On drill.

BEFORE the Exercise

1. If you will participate in a ShakeOut exercise, register your facility as an official participant at
www.ShakeOut.org (make sure to register in your state or region).
2. Bring together an Exercise Planning Team to design the exercise.
□ Determine or review your plans, policies and procedures for an earthquake.
3. If your facility participated in a prior ShakeOut Drill or Exercise, review past After Action Reports
and Improvement Plans.

4. Determine the exercise objectives.

What would you like your exercise to address? Potential issues to include for discussion:
□ Does the facility have a process to assess damage to hospital structure and infrastructure?
□ Would the facility lose power, water or medical gasses?
□ Does the facility have procedures to establish redundant communications internally and
externally?
□ Would facility access be limited?
□ How would transportation be affected?
□ Would transportation issues affect staff and patient access?
□ How would you decide evacuation versus shelter-in-place?
□ How and where would you evacuate patients?
□ What type of evacuation equipment does the facility have?
□ Who is trained to use the facility evacuation equipment?
□ How will you direct employees/staff during and immediately following the shaking?
□ Does the facility have procedures to track patients, beds, and staff?

Consider using the HICS Earthquake and Evacuation Incident Planning Guides to develop
objectives that are available at www.emsa.ca.gov/hics/hics.asp, www.hicscenter.org, and
www.calhospitalprepare.org – and is found under the scenario section.
5. Determine the scope and timeframe of your exercise.
Learn about potential earthquakes for your area and the Exercise Planning Team can use the
HICS Earthquake and Evacuation Scenarios available at www.emsa.ca.gov/hics/hics.asp,
www.hicscenter.org and www.calhospitalprepare.org as a base, or develop your own with
specific details of how you might expect the shaking to impact your facility (i.e., the building,
operations, service providers, employees, patients, and volunteers). For other ideas, review the
2008 San Andreas scenario at www.ShakeOut.org/scenario.

6. Develop a Situation Manual (SITMAN). Examples are available at www.calhospitalprepare.org and

https://hseep.dhs.gov.

7. Finalize the scenario; making sure it supports your exercise objectives.

8. Invite your facility’s key decision-makers (Exercise Planning Team, leaders, and key directors and
managers) to participate in the exercise. Have staff review appropriate plans and policies and
procedures prior to the exercise.
□ If your exercise is part of ShakeOut, encourage employees, volunteers, clients,
etc. to invite friends, families, and neighbors to
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Level 2 – Intermediate: Tabletop Exercise (con’t)

register at www.ShakeOut.org so they participate as well and receive information directly.

8. (Optional) Download realistic sound effects and safety information to play during your tabletop
exercise by downloading recordings from www.ShakeOut.org/resources.
9. Determine the addition of post-shaking evacuation procedures to the exercise, if needed:
□ Post-Shaking: Based on the age and type of your building, and the environment
inside/outside of building, etc., determine whether your facility would evacuate after a real
earthquake, or whether you would first assess the building’s damage before directing
employees to either stay put or evacuate.
□ Post-Earthquake Tsunami Threat: If your facility is in a coastal area, consider whether or not
you will need to have plans to evacuate to higher ground.

The Night BEFORE the Exercise

1. Create a brief written description of the earthquake’s impact using your hospital along with
questions that address the exercise objectives for participants to consider.
□ Tape the earthquake brief under desks and conference tables or provide participants sealed
envelopes to open during the exercise.
□ To increase participation, include a surprise under the desk (candy, light stick, lunch
coupons, etc.) While a serious subject, you can increase numbers by also adding some fun.
DURING the Exercise:
1. Invite your organization’s decision-makers (Exercise Planning Team, leaders, and key directors and
managers) assemble in a pre-determined room a few minutes before your exercise and share your
exercise objectives. When the exercise is announced, tell all participants to also Drop, Cover, and
Hold On.
2. Via your public announcement system, email, cell phone/text reminder or verbal direction:
□ Announce that the exercise has begun and to Drop, Cover, and Hold On.
□ (Optional) Play the audio recording (see above) on your PA.
□ Suggest that while down on the floor, participants and all staff look around at what might fall
on them during a real earthquake. Secure or move items after the exercise to prevent injury
and damage.
3. After at least one minute, announce that the shaking is over and for everyone to stand up again.
4. In the room with the Tabletop Exercise participants:
□ Have everyone sit back at the table.
□ Provide the exercise Situation Manual.
□ Read your scenario with details of the earthquake impacts.
□ To make the potential impact more vivid, you can show the downloadable video of expected
shaking. This can be found on the ShakeOut website: www.ShakeOut.org/resources.

5. Now go around the table to discuss what your facility can expect to happen and decisions that will
be made based on the scenario.
□ Try to have the discussion flow in chronological order of what would be the expected
activities and priorities in the first minutes, hours, days, etc. following the details of the
scenario and brief.
□ However, if all issues are solved within a particular timeframe, move the scenario timeline
forward to day/week/month later and begin the discussion again to address new issues.

6. Have someone document the issues, and proposed solutions. Which policy decisions need to be
made in advance? What changes in practice are required? What plans, policies and procedures
need developed or updated?

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Level 2 – Intermediate: Tabletop Exercise (con’t)

AFTER the Exercise
1. For your general employee population, hold hotwash/staff meetings as soon as possible after the
Drop, Cover, and Hold On focus drill portion to discuss what happened, people’s experience during
the drill, what they were thinking about, what caused concern, what worked well and what did not
work well. Take this opportunity to:
□ Discuss the importance of preparedness at work and at home. (Staff’s and volunteers’
home/family preparedness will allow them to either stay at work, or return to work more
rapidly, to support your organization’s mission and recovery).
□ Review post-disaster employee responsibilities.
□ Update emergency contact lists and go over phone tree procedures.
□ Discuss your safety and organization resumption priorities.
□ Discuss staff emergency responsibilities and potential Hospital Incident Command (HICS)
roles.
□ Share lessons learned from the exercise or real experiences.
□ Listen attentively to staff suggestions.
2. At your management level:
□ Review staff and management emergency responsibilities.
□ Discuss staff notification procedures (phone tree or mass notification tools) and ensure
emergency contacts lists are kept up to date.
□ Review and recommend safety and operations resumption priorities for your Emergency
Operations Plan.

3. For the Tabletop Exercise participants, verify whether you met your exercise objectives or not.
Discuss what happened regarding people’s experience, areas of concern, and what worked well or
did not, and then document all comments to officially end the exercise.
4. Determine your next steps and assign people to those tasks to follow-up.
□ Assemble data gathered to develop After Action Report
□ Develop an Improvement Plan to address areas of improvement.
□ Assign a team to begin reviewing or updating your Emergency Operations Plan and other
policies and procedures based on experiences from this exercise.
□ Discuss the importance of preparedness at work and at home encouraging participation.
5. Review “7 Steps to an Earthquake Resilient Business” for additional ideas, available at
www.earthquakecountry.org/roots.

6. Schedule next exercise one year from now (or sooner) so employees can practice life safety actions
and to exercise the emergency procedures of your Emergency Operations Plan, especially after
changes.

7. Share your stories and photos at www.ShakeOut.org.

8. Encourage employees to prepare at home using the 7 Steps to Safety from “Putting Down Roots in
Earthquake Country” (see www.earthquakecountry.org).

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Level 3 – Advanced: Functional Exercise

This operations-based exercise tests command and control during a major earthquake including
emergency response and/or recovery duties in your Emergency Operations Plan. The exercise
incorporates simulated incidents, decision-making, and policies tested, and then a review afterwards to
discuss what worked or what did not in order to make changes for the next earthquake or exercise.

BEFORE the Exercise

1. If you will participate in the ShakeOut exercise, register your facility as an official participant at
www.ShakeOut.org (make sure to register in your state or region).
2. Bring together the Exercise Planning Team to design the exercise.
□ Determine or review your plans, policies and procedures for an earthquake.
3. If your facility participated in a prior ShakeOut Drill or Exercise, review past After Action Reports
and Improvement Plans.

4. Determine the exercise objectives.

What would you like your exercise to address? Potential issues to include for discussion:
□ Does the facility have a process to assess damage to hospital structure and infrastructure?
□ Would the facility lose power, water or medical gasses?
□ Does the facility have procedures to establish redundant communications internally and
externally?
□ Would facility access be limited?
□ How would transportation be affected?
□ Would transportation issues affect staff and patient access?
□ How would you decide evacuation versus shelter-in-place?
□ How and where would you evacuate patients?
□ What type of evacuation equipment does the facility have?
□ Who is trained to use the facility evacuation equipment?
□ How will you direct employees/staff during and immediately following the shaking?
□ Does the facility have procedures to track patients, beds, and staff?

Consider using the HICS Earthquake and Evacuation Incident Planning Guides to develop
objectives that are available at www.emsa.ca.gov/hics/hics.asp, www.hicscenter.org, and
www.calhospitalprepare.org – and is found under the scenario section.
5. Determine the scope and timeframe of your exercise.
□ For example, test a specific part of your organization’s emergency plan for an hour.

Learn about potential earthquakes for your area and the Exercise Planning Team can use the HICS
Earthquake and Evacuation Scenarios available at www.emsa.ca.gov/hics/hics.asp,
www.hicscenter.org, www.calhospitalprepare.org as a base, or develop your own with specific
details of how you might expect the shaking to impact your facility (i.e., the building, operations,
service providers, employees, patients, and volunteers). For other ideas, review the 2008 San
Andreas scenario at www.ShakeOut.org/scenario.

6. Develop an Exercise Plan (EXPLAN). Examples are available at www.calhospitalprepare.org and

https://hseep.dhs.gov.

7. Finalize the scenario; making sure it supports your exercise objectives.

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Level 3 – Advanced: Functional Exercise (con’t)

8. Select an Exercise Director to run the exercise. Determine other staffing role requirements such as
assigning personnel as observers, and evaluators to document activities in chronological order.

9. Ensure training of all exercise participants, such as Hospital Incident Command System – HICS
updates and evacuation equipment training, so they are fully aware of their roles and
responsibilities. All participants, evaluators and decision-makers should review the disaster plan.

10. Create a Master Scenario Events List (MSEL) that is a timeline for your exercise, such as:
□ 1000 a.m. – Earthquake starts, employees Drop, cover, and Hold On.
□ 1001 a.m. – Lights go out and computers go down.
□ 1003 a.m. – Sprinklers in South East corner of first floor turn on.

MSEL templates and examples are available at www.calhospitalprepare.org and

https://hseep.dhs.gov.

The MSEL includes a list of “injected events.” “Injects” are surprise events that could reasonably
occur during the exercise (e.g., aftershocks, specific problems related to your services, etc.). These
events can be “injected” (or provided to the participants in the form of a note, a person acting out a
role in the exercise, etc.) periodically during the exercise to get participants thinking of issues and
solutions without overwhelming them.

11. (Optional) Download realistic sound effects and safety information to play during your drill by
downloading recordings from www.ShakeOut.org/resources.

12. Inform your employees/staff, volunteers and patients:

□ The date and time of your exercise
□ How to correctly perform Drop, Cover, and Hold On, wherever they are.
o This includes taking cover beneath a sturdy table or desk, or dropping to the floor
near an interior wall and covering your head with your hands and arms.
o Develop special procedures for unique locations such as rooms and offices with
glass walls.
□ Your expectations for their participation (i.e., Drop, Cover and Hold On, gathering at a
central location for a head count, playing a role such as a “injured” that will need medical
assistance, and/or having post-exercise discussions, etc.).
□ If your exercise is part of the Great California ShakeOut, encourage employees, volunteers,
etc. to invite friends, families, and neighbors to register at www.ShakeOut.org, in their
region, so they participate as well and receive information directly.

13. Determine the addition of the post-shaking evacuation procedures to the exercise, if needed:
□ Post-Earthquake: Based on the age and type of your building, and the environment
inside/outside of building, etc., determine whether your facility would evacuate or Shelter-in-
Place after a real earthquake, and how you would first assess the building’s damage before
directing employees to either stay put or evacuate. Consider new safety hazards outside of
your facility caused by the shaking.
□ Post-Earthquake Tsunami Threat: If your facility is in a coastal area, consider whether or not
you need to have plans to evacuate to higher ground.

The Night BEFORE the Exercise

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1. Create a brief written description of the earthquake’s impact using your scenario along with some
questions for employees to consider.

Level 3 – Advanced: Functional Exercise (con’t)

□ Tape this description under desks and conference tables or provide employees sealed
envelopes to open during the exercise. (You can use email, but it is more affective if they do
not read this until during the exercise.)
□ To increase participation, include a surprise under the desk (candy, light stick, lunch
coupons, etc.) While a serious subject, you can increase numbers by also adding some fun.

DURING Exercise
1. Via your public announcement system, email, cell phone/text reminder or verbal direction:
□ Announce that the earthquake drill has begun and to Drop, Cover, and Hold On.
□ (Optional) Play the audio recording (see above) on your PA or, alternatively, play it on a
computer in each office.
□ Suggest that while down on the floor, employees look around at what might fall on them
during a real earthquake. Secure or move items after the drill to prevent injury and damage.

2. After at least one minute, announce that the shaking is over and for everyone to stand up again.
3. Announce the beginning of the exercise and for employees to follow their response procedures.

4. As the exercise progresses distribute individual “inject events” to specific participants. Have
exercise evaluators observe and document how these surprise issues are handled.

5. When the exercise objectives are met, announce that the exercise is over

AFTER the Exercise

1. Assemble the Exercise Director and evaluators with their documentation to summarize activities,
actions, decisions, and solutions from the exercise.
□ Discuss whether you met your exercise objectives or why not.
□ Document lessons learned, best practices and necessary actions to improve your employee
training, emergency procedures, and incorporate into the Emergency Operations Plan.
2. Hold hotwash/staff meetings/debriefings as soon as possible after the exercise so all
employees/staff can discuss and document what happened during the exercise, what decisions
were made, what worked, what didn’t, etc. Take this opportunity to:
□ Discuss preparedness at work and at home. (Employees’ and volunteers’ home/family
preparedness will allow them to either stay at work (or return to work more rapidly) to
support your organization’s mission and recovery).

3. Next, assemble exercise participants including your decision-makers and leaders.

□ Depending on the size of your facility, you may need to have groups meet separately,
followed by a leadership meeting with representatives from each group.
□ Discuss and document comments of what happened during the exercise, what decisions
were made, what worked, what didn’t, etc.
□ Listen attentively to staff suggestions.
□ Encourage the sharing of lessons learned from the exercise or real experiences.
□ Review pre and post-disaster employee responsibilities.
□ Discuss need to update emergency contact lists and any other critical documents in plan.
□ Discuss any changes to your safety and organization resumption priorities.
□ Discuss possible changes to company staff emergency responsibilities.
□ Cover the importance of preparedness at work and at home, encouraging participation.

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□ Document and accept all comments then thank all the participants to officially end the
exercise.

Level 3 – Advanced: Functional Exercise (con’t)

4. At your Emergency Preparedness Planning level:

□ Develop After Action Report and Improvement Plan.
□ Review lessons learned and recommendations to be added to the plan.
□ Update staff and management emergency responsibilities.
□ Discuss process to keep critical documents up to date.
□ Determine or assign staff update your Emergency Operations Plan with lessons learned
from the exercise.
□ Review the updated Emergency Operations Plan and associated policies and procedures
with recommended safety and operations resumption priorities and procedures.

5. Determine next steps and assign people to those tasks to follow-up.

□ Schedule training as needed to address plan changes.
□ Make sure future exercises follow trainings so that employees can work through the most
current procedures.

6. Schedule next exercise one year from now (or sooner) so employees can practice life safety
procedures, decision-making, and to exercise the emergency procedures of your Emergency
Operations Plan.

7. Share your exercise stories and photos at www.ShakeOut.org.

8. Review “7 Steps to an Earthquake Resilient Business” for additional ideas, available at

www.earthquakecountry.org/roots.

9. Encourage employees to prepare at home using the 7 Steps to Safety from “Putting Down Roots in
Earthquake Country” (see www.earthquakecountry.org).