Planning and executing complex large-scale exercises.

INTRODUCTION Increasingly, public health departments are designing and engaging in complex operations-based full-scale exercises to test multiple public health preparedness response functions. The Department of Homeland Security's Homeland Security Exercise and Evaluation Program (HSEEP) supplies benchmark guidelines that provide a framework for both the design and the evaluation of drills and exercises; however, the HSEEP framework does not seem to have been designed to manage the development and evaluation of multiple, operations-based, parallel exercises combined into 1 complex large-scale event. METHODS Lessons learned from the planning of the Mississippi State Department of Health Emergency Support Function--8 involvement in National Level Exercise 2011 were used to develop an expanded exercise planning model that is HSEEP compliant but accounts for increased exercise complexity and is more functional for public health. RESULTS The Expanded HSEEP (E-HSEEP) model was developed through changes in the HSEEP exercise planning process in areas of Exercise Plan, Controller/Evaluator Handbook, Evaluation Plan, and After Action Report and Improvement Plan development. The E-HSEEP model was tested and refined during the planning and evaluation of Mississippi's State-level Emergency Support Function-8 exercises in 2012 and 2013. DISCUSSION As a result of using the E-HSEEP model, Mississippi State Department of Health was able to capture strengths, lessons learned, and areas for improvement, and identify microlevel issues that may have been missed using the traditional HSEEP framework. NEXT STEPS The South Central Preparedness and Emergency Response Learning Center is working to create an Excel-based E-HSEEP tool that will allow practice partners to build a database to track corrective actions and conduct many different types of analyses and comparisons.