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U.S. Department of Health and Human Services

Section 3: Coalition Surge Test Performance Measure

This section contains PMs that use data produced during the annual CST. These PMs are aligned to the requirements of the 2019 FOA. For a crosswalk of PMs to the 2017-2022 Health Care Preparedness and Response Capabilities, see Appendix 3: Crosswalk of Performance Measures to 2017-2022 Health Care Preparedness and Response Capabilities.

The CST measures were waived for FY2019 (July 1, 2019 – June 30, 2020) due to COVID-19 response.

ASPR recognizes that HCCs are diverse, and their response capacities may vary. To gauge the full extent of HCC performance, ASPR selected eight PMs to assess the speed and extent to which HCCs can coordinate an evacuation exercise. The eight PMs assess participation and both time- and percent-based outcomes. In aggregate, these eight PMs should enable greater understanding of HCCs’ preparedness capacities.

The following table lists the data entity—the organizational level at which the data are captured (recipients or HCC)—and PM type for each PM:


Measure (PM)

​Performance Measure (PM) Definition​​

Data Entity

PM Type

14​Percent of HCC core member organizations participating in Phase 1: Table Top Exercise with Functional Elements and Facilitated Discussion of the Coalition Surge Test HCC Output
15 Percent of HCC core member organizations with at least one executive participating in Phase 2: After Action Review of the Coalition Surge Test​ HCC  Output
16 Percent of patients at the evacuating facilities that are identified as able to be: a) discharged safely to home or b) evacuated to receiving facilities during Phase 1: Table Top Exercise with Functional Elements and Facilitated Discussion of the Coalition Surge Test​ HCC  Outcome
17 Time [in minutes] for evacuating facilities in the HCC to report the total number of evacuating patients​ HCC Outcome
18 Percent of evacuating patients with an appropriate bed identified at a receiving health care facility in 90 minutes​ HCC Outcome
19 ​Time [in minutes] for receiving facilities in the HCC to report the total number of beds available to receive patients HCC Outcome
20​Percent of evacuating patients with acceptance for transfer to another facility that have an appropriate mode of transport identified in 90 minutes HCC Outcome
21 ​Time [in minutes] for the HCCs to identify an appropriate mode of transport for the last evacuating patient HCC Outcome

The definitions for the PM types are:

  • Output: Products and services produced by HPP activities; and,
  • Outcome: Changes or benefits resulting from program activities and outputs. Outcomes can be intended or unintended, positive or negative, and are often divided into short-, intermediate-, and long-term timeframes.

Coalition Surge Test

The CST captures information on HCC performance that directly informs the PMs. The CST tests a coalition’s ability to work in a coordinated way, using their own systems and plans to find appropriate destinations for patients by using a simulated evacuation of inpatient facilities (that collectively represent at least 20 percent of a coalition’s staffed acute care bed capacity). The detailed exercise manual and evaluation tools can be viewed online. In the event that an HCC has a real-world evacuation of at least 20 percent of a coalition’s total staffed acute care bed capacity during the reporting year, the HCC can use the data from the real-world evacuation to respond to each applicable PM. If a real-world evacuation occurs during the reporting year, the HCC must still submit an AAR/IP that specifically responds to each applicable PM.

The CST includes a low- to no-notice exercise. Low- to no-notice exercising is important for ensuring that HCCs can transition quickly and efficiently into “disaster mode” and providing a more realistic picture of readiness than pre-announced exercises. At least one month in advance, a trusted insider will identify the assessment team and inform HCC members of the two-week window in which the CST will occur. HCC members will not know the exact date and time, and they will not know whether they are playing the role of “evacuating” or “receiving” facility until 60 minutes before the start of the exercise.

The CST is designed to be challenging. Struggling with a challenging exercise may be more helpful in the long run than succeeding with an easier one. Within 90 minutes, an HCC should be able to identify the beds it can make available, determine the patient placements necessary, match patients to those beds, and identify transportation resources appropriate for each patient. While no patients will be moved during the exercise, the actual movement of patients during a real evacuation event may not happen within the 90 minutes of Phase 1 (during the CST, some HCCs may not be able to identify beds and transportation for all patients within 90 minutes).

The CST is intended to improve health care system response readiness. HCCs will select their own peer assessors who can provide exacting, but constructive, feedback to improve response.

The CST tests the overall health care system response. Although the exercise simulates a health facility evacuation, it can reveal preparedness capabilities needed for a number of different scenarios. These capabilities may include emergency operations coordination, information sharing, and medical surge capacity.

The entire CST takes approximately four hours to complete and includes the following phases:

  • Phase 1: Table Top Exercise with Functional Elements and Facilitated Discussion (180-210 minutes)

    The exercise starts 60 minutes after the assessment team notifies one or more hospitals or other patient-care facilities that they need to stand up their facility command centers. The exercise ends when all patients are placed or after 90 minutes, whichever comes first; participants will then join a facilitated discussion that explores issues raised during the exercise. The facilitated discussion may include: patient transportation planning, receiving health care facility capacity, patient tracking and public information, the needs of vulnerable patients, and continuity of operations.

  • Phase 2: After Action Review (30-45 minutes)

    An after action review concludes the CST and consists of an assessment of strengths and weaknesses and corrective action planning. Ideally, this should occur immediately after Phase 1, but it can be scheduled for a later date to maximize health care executive participation; however, it must occur within 30 days of Phase 1.

ASPR will use measures within the CST to assess achievement of preparedness goals for the health care system. Pursuant to Section 319C-1(g)(5) of the Public Health Service Act, failure to achieve this benchmark for one of two consecutive years may result in withholding of 10% of funding amounts and increased withholding amounts in subsequent years that this benchmark is not met.

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  • This page last reviewed: November 05, 2020