Health Care Medical Response and Surge Exercise

The Medical Response and Surge Exercise (MRSE) is an annual requirement of the Hospital Preparedness Program (HPP) cooperative agreement. As of HPP Budget Period 3 (starting on July 1, 2021 and ending June 30, 2022), health care coalitions (HCCs) must complete the MRSE annually.

The MRSE officially replaces both the Coalition Surge Test (CST) and the Hospital Surge Test (HST). 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 designed to examine and evaluate the ability of HCCs and other stakeholders to support medical surge. Placing stress on the health system is important for testing current response systems, identifying gaps in preparedness, and informing improvement planning.

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 the 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.

Executing the MRSE

The MRSE follows three exercise phases:

• Phase I: Plan & Scope. HCCs will begin this phase well in advance of the beginning of the actual exercise. HCCs will determine exercise roles, understand members’ specific needs from the exercise, define the surge scenario, and begin to enter planning and scoping data into the MRSE Exercise Planning and Evaluation Tool.
• Phase II: Exercise. HCCs will largely follow the standard response actions included in their HCC Response Plan or other jurisdictional response plan.
• Phase III: Review (After-Action Review and Improvement Planning). HCCs will document key findings through the AAR, which outlines participant discussion topics, highlighting strengths, areas for improvement, decisions, and recommendations identified by participants during the exercise.

MRSE Updates

Your feedback has been critical to the development of the MRSE. Based on the comments and lessons learned this year, updates have been made to the MRSE to include the creation of a Real-World Incident Reporting and Evaluation Tool for HCCs to use if they choose to use a real-world incident in lieu of the exercise. Both the Exercise Tool and Real-World Tool are available in the Coalition Assessment Tool (CAT). Please note that if HCCs opt to use a real-world incident for the MRSE, the Questionnaire on the first tab of the Real-World Incident Reporting and Evaluation Tool must be submitted to the recipient and Field Project Officer (FPO) for review and approval, to determine that the event meets the minimum MRSE requirements.

The Patient Surge Summary table in both the MRSE Exercise Planning and Evaluation Tool and the Real-World Incident Reporting and Evaluation Tool has been pared down to reduce data collection burden for Performance Measure 19.

In the coming months, the MRSE support team is working to create a MRSE Resource Library that will provide additional materials to aid healthcare coalitions with planning and execution of the MRSE. Please continue to share your feedback with our team via the MRSE mailbox: MRSE@hhs.gov.