Prehospital and Disaster Medicine

Brief Report

A Consensus Process on the Use of Exercises and After Action Reports to Assess and Improve Public Health Emergency Preparedness and Response

Elena Savoiaa1 c1, Jessica Prestona2 and Paul D. Biddingera2a3

a1 Division of Policy Translation and Leadership Development, Harvard School of Public Health, Boston, Massachusetts USA

a2 Preparedness and Emergency Response Research Center, Department of Society Health and Human Development, Harvard School of Public Health, Boston, Massachusetts USA

a3 Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA


Introduction The objective of disaster preparedness is to ensure that appropriate systems, procedures, and resources are in place to provide prompt, effective assistance to disaster victims, thus facilitating relief measures and rehabilitation of services. Disaster preparedness efforts include the identification of possible health scenarios based on the probability of hazards and vulnerability of the population as a basis for creating a disaster plan. Exercises that simulate emergency response, involving the health and other sectors, have been suggested as useful tools to test the plans on a regular basis and measure preparedness efforts; the absence of actual testing is likely to negate even the best of abstract plans.

Problem Exercises and after action reports (AARs) are used to document preparedness activities. However, to date, limited analysis has been performed on what makes an exercise an effective tool to assess public health emergency preparedness (PHEP), and how AARs can be developed and used to support PHEP improvement efforts. The scope of this project was to achieve consensus on: (1) what makes an exercise an effective tool to assess PHEP; and (2) what makes an AAR an effective tool to guide PHEP improvement efforts.

Methods Sixty-one PHEP experts were convened by the use of Nominal Group Techniques to achieve consensus on a series of characteristics that exercises should have when designed to assess PHEP and on the recommendations for developing high-quality AARs.

Results The panelists achieved consensus on a list of recommendations to improve the use of exercises and AARs in PHEP improvement efforts. Such recommendations ranged from the characteristics of the exercise audience to the evaluation methodology being used and the characteristics of the produced AAR such as its structure and content.

Conclusions The characteristics of the exercise audience, scenario and scope are among the most important attributes to the effectiveness of an exercise conducted for PHEP evaluation purposes. The evaluation instruments used to gather observations need an appropriate matching between exercise objectives and the response capabilities tested during the exercise, to build the base for the production of a good AAR. Improvements in the design and creation of exercises and AARs could facilitate better reporting and measurement of preparedness outcomes.

E Savoia, J Preston, PD Biddinger. A consensus process on the use of exercises and after action reports to assess and improve public health emergency preparedness and response. Prehosp Disaster Med. 2013;28(3):1-4 .

(Received September 14 2012)

(Revised January 27 2013)

(Accepted February 08 2012)

(Online publication March 28 2013)


  • after action reports;
  • emergency preparedness;
  • exercises;
  • quality improvement


  • AAR:after action report;
  • CDC:US Centers for Disease Control and Prevention;
  • MYTEP:multi-year training and exercise plan;
  • NGT:nominal group technique;
  • PHEP:public health emergency preparedness;
  • QI:quality improvement


c1 Correspondence: Elena Savoia, MD, MPH Division of Policy Translation and Leadership Development Harvard School of Public Health 401 Park Drive Boston, MA 02115 USA E-mail


  Conflicts of interest and funding: The authors report there are no conflicts of interest. Funding support was received from the US Centers for Disease Control and Prevention (CDC) grant number 5PO1TP000307-04, Preparedness and Emergency Response Research Center - Linking Assessment to Measurement and Performance in Public Health Emergency Preparedness Exercises.