Cluster 3: preparing responders and their organisations
The U.K. research studies (Anathallee et al, 2007; Williams et al, 2007; Fell, 2008; Day et al, 2010) typically indicate shortfalls in the emergency preparedness of health-care services. Training and exercises are a major component of developing preparedness, but knowledge is lacking regarding their effectiveness. There may also be untapped potential to learn from past experiences and to make use of quality improvement methods. Responding organisations generally debrief after any significant incident producing a report known as an After Action Report in the United States. These reports may be circulated locally, with particular recommendations and learning points being followed up, but no structured attempts have been made to collate, compare and learn from them on a larger scale. The reports represent an underused resource to improve practice, to recognise business continuity issues and also to identify emerging threats and patterns. Training and exercises both train the participants to deal with specific features of events, and build trust and understanding. However, exercises tend to rehearse wellanticipated events that run to plan, to consider only the worst case scenario and to cover all functions and address all issues within all the allotted time. There is a danger of superficiality and of failing to consider conjunctions of events that can compromise planning assumptions. Generally there is an issue of professional training for emergency managers and ways of sharing best practice. In the study interviews, no clear mechanisms were identified for the professional training of emergency managers other than membership of certain professional bodies, taking part in exercises and attending planning meetings. Interviewees observed that senior emergency planners may
have worked their way up from being responders. This provides them with a valuable wealth of practical experience, but a paucity of relevant theory and body of evidence on which to build appropriate behavioural and management competencies.