Frequently Asked Questions
Medical Response and Surge Exercise (MRSE)

The Medical Response and Surge Exercise (MRSE) is an annual Hospital Preparedness Program (HPP) Cooperative Agreement requirement and officially replaces both the Coalition Surge Test (CST) and the Hospital Surge Test (HST). As of HPP Budget Period 3 (starting on July 1, 2021 and ending June 30, 2022), HCCs must complete the MRSE annually. Previously, the Hospital Surge Test was used for hospitals located in approved jurisdictions or officially classified as an isolated frontier hospital. Now hospitals located in approved jurisdictions (American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Republic of Palau, Republic of the Marshall Islands, Guam, and the United States Virgin Islands) or officially classified as an isolated frontier hospital must also complete the MRSE.

The MRSE is a functional exercise. Federal Emergency Management Agency (FEMA) Homeland Security Exercise and Evaluation (HSEEP) guidelines describe a functional exercise as “an operations-based exercise designed to test and evaluate capabilities and functions while in a realistic, real-time environment.” HCCs are welcome to use MRSE as a full-scale event, provided all MRSE requirements are met and that the HCC can report the data required to calculate the MRSE performance measures.

There are several differences between the CST/HST and the MRSE. Some of the salient changes include:

• Removal of the low- or no-notice requirement
• Removal of a time limit for the exercise (previously 90 minutes)
• Including flexibility for the HCC to define its surge scenario
• Enabling greater linkages to other program components (e.g., Hazard Vulnerability Analysis (HVA), each HCC’s individual response plan)
• Increasing opportunity to meet non-HPP exercise requirements such as those required by Centers for Medicare and Medicaid Services (CMS), the Joint Commission, and state/local authorities
• Use of only five required bed types in the 20% surge calculation, rather than all HCC staffed beds. Additional bed types may be added by your HCC depending upon your surge scenario
• Increasing the ability of HCCs to utilize a qualifying real-world incident in lieu of the MRSE
  

Some aspects of the CST/HST have been maintained. These include:

• HCCs are required to complete the exercise annually
• The exercise remains a source of performance data for HPP
• HCCs are required to enter exercise data into the Coalition Assessment Tool (CAT) annually to comply with HPP reporting requirements

All steps of planning for and completing the MRSE are outlined in the following tools:

• Situation Manual – The core document provided to all participants in an exercise. It provides in-depth instructions for how to plan and conduct the MRSE.
• Evaluation Plan – The document that outlines the goals and purpose of exercise evaluation for an HCC and guides the Exercise Evaluator through assisting during the exercise, gathering information, and facilitating the After-Action Review. The Evaluation Plan helps the Exercise Evaluator turn information collected during the exercise into a meaningful After-Action Review and Improvement Plan in concert with exercise participants.
• Exercise Planning and Evaluation Tool – This tool is organized to walk HCCs through conducting the exercise and collecting all exercise data. All required exercise data collection – including data for HPP Cooperative Agreement MRSE performance measures – will be completed in the Exercise Planning and Evaluation Tool.

Data from the MRSE must be submitted by HCCs into the Coalition Assessment Tool (CAT). HCCs are required to submit MRSE performance measure information and to upload the MRSE Exercise Planning and Evaluation Tool into the CAT.

HPP allows HCCs to utilize a real-world incident in lieu of conducting the Medical Response and Surge Exercise. The MRSE Situation Manual provides HCCs with guidance and parameters for using real-world incidents. HCCs are asked to use their judgement in selecting an appropriate real-world incident. Some criteria have been provided to help HCCs determine what is an appropriate use of a real-world incident. These criteria are listed below:

• The real-world surge incident must impact greater than or equal to 20% of the required staffed bed types and other scenario-specific staffed bed types used in the MRSE (see the Calculating the Scale of the Surge section in the MRSE Situation Manual)
• At least one of each of the HCC core members must participate in the real-world incident response
• At least one executive from each of the participating core member organizations must participate in the After-Action Review (AAR)
• The HCC must be able to capture the data points required to report all MRSE performance measures. To strengthen the possibility of meeting this requirement, HCCs can pre-identify resource needs for a range of surge incident types (e.g., from the HCC Hazard Vulnerability Analysis) as explained in the Identifying Anticipated Resources Required for the Surge section in the MRSE Situation Manual
• The HCC must use the Exercise Planning and Evaluation Tool to document the real-world incident and provide data required by HPP (e.g., performance measures)
• The HCC must submit an AAR and Improvement Plan to HPP after the real-world incident in line with the reporting requirements of the HPP Cooperative Agreement for both exercises and real-world incidents. The real-world surge incident must have a discrete beginning and end (‘bookends’) rather than a slow build up. Preferred real-world incidents to be used in lieu of the MRSE last no more than one week. Generally speaking, the COVID-19 response cannot be used in lieu of conducting the MRSE unless there is a specific COVID-19 surge event lasting less than one week. Ongoing COVID-19 surge, therefore, is not an appropriate real-world incident to use in lieu of the MRSE. However, a four-day surge of pediatric COVID-19 cases may be an appropriate scenario if the four-day surge is greater than or equal to 20% of the current staffed beds and the timeframe of the real-world surge incident occurs in less than a week.

Please consult the Evaluation Plan to learn more about MRSE performance measures. If, after reading the MRSE Situation Manual’s guidance for real-world events and the Evaluation Plan, you still have questions about the appropriateness of using a real-world incident or how to report the data, please consult your recipient and your HPP Field Project Officer (FPO) or reach out to the MRSE Support Team at MRSE@hhs.gov.

Currently, all HCCs are required to conduct the MRSE in each budget period beginning with BP3 of the current cooperative agreement project period. Currently, there are no exemptions. National Healthcare Preparedness Programs (NHPP) leadership continuously monitors impacts of the COVID-19 response on recipients and sub-recipients. HPP understands that the current situation in many hospitals and other member organizations is challenging and will continue to be challenging. However, we at HPP believe there are many risks to our health care system that remain while we battle COVID-19. HCCs have until June 30, 2022 to complete this exercise. If you have additional questions specific to your situation, you can work with your recipient and your HPP FPO.

No. This is not a requirement for the MRSE. Core members of the HCC are required participants in the MRSE. Although HPP encourages all core members to participate in every exercise, the HCC should include at least one participant from each of the four core member types. Participation beyond the one representative of each type is dependent on the exercise scenario designed by the HCC.