Tabletop Exercise Research Articles

Enhancing port preparedness in Germany in the event of infectious diseases – a best practice study

Abstract Background The maritime sector is exposed to specific risks in the area of communicable diseases. In Germany, five ports are designated to enforce the International Health Regulations (IHR) and must have certain core capacities to respond immediately to cross-border health threats. A joint external evaluation conducted by the World Health Organization (WHO) revealed a need to reinforce central structures in Germany. The overarching objective of the study is to harmonize and consolidate the requisite capacities for maritime health security. Methods Qualitative interviews (n = 35) at baseline were conducted with various stakeholders, including port medical services, port authorities and other stakeholders. The parameters to be analysed included specific activities and interfaces during infectious incidents, experience with past infection incidents, training and exercise, and the need for action. Furthermore, a document analysis was conducted, during which the existing contingency plans and standard operating procedures were reviewed. Results In essence, the initial challenges posed by the COVID-19 pandemic have led to the establishment of well-defined procedures and interfaces between the various stakeholders involved. There is a necessity for enhanced interpersonal communication between the various stakeholders and the implementation of sustainable training practices. Furthermore, greater transparency and standardisation of regulations in international health emergencies is desired. Conclusions Given the infrequency of cross-border infection incidents on board ships, targeted preparation within stakeholders is often given a lower priority than other work priorities. The participatory study design is intended to develop comprehensive concepts in collaboration with the IHR ports in the ongoing project. Subsequently, these concepts will be tested in tabletop exercises and incorporated into training formats for public health actors. Key messages • The qualitative interview study at baseline revealed a substantial need for sustained communication and training practices among stakeholders for infectious disease preparedness in German IHR ports. • The document analysis revealed relevant differences in the extent and scope of contingency plans of German ports designated under the International Health Regulations.

Use of Standard Operating Procedures for Supporting Cross-Organizational Emergency Management: Challenges and Opportunities Identified from a Tabletop Exercise

AbstractThis study investigated the crucial role of formulating and applying standard operating procedures (SOPs) in the context of emergency planning and response. The effective application of SOPs during operations is essential in order to address challenges that surpass individual organizational capacities. A specific focus on fostering efficient information sharing and executing specified actions maximizes the prospect of success. To explore the collective functionality of SOPs across organizations, we conducted a comprehensive tabletop exercise involving 10 organizations spanning tactical, operational, and strategic levels. Our analysis identified six key challenges, primarily related to the structures for information sharing, communication pathways, and the complex integration and application of common SOPs within these diverse organizational contexts. This research contributes insights into the use of SOPs in large-scale, cross-organizational scenarios.

Radiotelephony Untuk Personel Pangkalan TNI AU Atang Sendjaja

In the aviation industry, radiotelephony is the primary communication tool between pilots and personnel involved in aircraft operations. According to the Director General of Civil Aviation Regulation Number KP 038 of 2017, personnel providing apron management services are required to have specific licenses, such as Air Traffic Controllers, Aeronautical Communication Officers (ACO), or Apron Movement Controllers (AMC), with additional skills in radiotelephony. However, the personnel at the Atang Sendjaja Air Force Base currently do not meet the radiotelephony competency requirements. To perform services according to national and international standards, the use of radiotelephony is essential. To address this need, a training program was conducted as part of a community service initiative, aimed at equipping personnel with radiotelephony skills in line with applicable regulations. This training includes both theoretical and practical sessions conducted on-site, utilizing table-top exercise simulation methods. The outcome of this training indicates that the personnel at the Atang Sendjaja Air Force Base have acquired adequate skills to implement radiotelephony in their daily operational activities.

Leveraging Collaborative Partnerships to Enhance NWS and Emergency Management Communications through Exercising

Abstract Tabletop exercises examining weather-related hazards are not uncommon but are often built around somewhat generic scenarios that only touch on the meteorological communication environment at a very shallow level. A recent exercise in central Oklahoma sought to change that. A local emergency manager, personnel from a National Weather Service (NWS) forecast office, and a severe weather researcher with a background in exercise design and facilitation worked together to create and deliver a realistic severe weather simulation. Exercise participants were exposed to detailed forecast information via NWSChat—a dedicated communication tool used to connect NWS forecasters, emergency managers, and media members for real-time information sharing. NWS forecasters were able to both actively play in the exercise due to the use of NWSChat and observe how local decision-makers interpreted and utilized the impact-based decision support service (IDSS) graphics and short-term forecast updates. The collaborative approach of developing a detailed scenario with numerous real-world IDSS graphics, along with the use of NWSChat for real-time delivery, resulted in overwhelmingly positive feedback from the participants. The local emergency management office identified numerous areas for improvement in communicating real-time forecast information across their jurisdiction, along with gaps in current plans and resources. Meanwhile, the NWS forecast office had the opportunity to experiment with using the new NWSChat platform in a high-impact severe weather environment before a real-world event took place. Forecasters also gained insight into current IDSS graphic interpretation, noting areas for improved messaging to end users, such as adding storm motion to existing severe weather graphics.

Interprofessional Education Collaboration between Chung Ang Medical School and Sungshin Nursing School

Interprofessional collaboration is crucial for patient-centered care and safety. Since healthcare students will be part of interprofessional teams in the future, they need to understand the unique contributions of various healthcare professions to patient care and develop skills in collaboration, communication, leadership, and mutual respect. In response to this need, healthcare faculties have adopted interprofessional education as an innovative teaching method. However, traditional health education has typically taken place within individual schools, resulting in a limited understanding of other professional roles and identities. In our study, we introduced an interprofessional education model involving two different colleges. A total of 152 undergraduate students, comprising 101 medical students from Chung Ang University and 51 nursing students from Sungshin Women’s University, participated in the program. A one-day interprofessional education program was conducted to promote collaboration between medical and nursing students. The program included team building and communication games, scenario-based simulations, such as a “room of errors,” and tabletop exercises. Key factors for successful interprofessional education include carefully planned scheduling, leadership, and commitment from participating colleges, faculty support and training, the use of diverse teaching methods and technology, and alignment regarding educational directions among the faculty. We believe that this model may provide valuable insights for healthcare institutions aiming to develop and implement interprofessional curricula.

A tabletop exercise approach to global disaster preparedness: insights from Nepal's first international conference on disaster preparedness and management.

Considering recent earthquakes and the COVID-19 pandemic, disaster preparedness has come to the forefront of the public health agenda in Nepal. To strengthen the developing health system, many initiatives are being implemented at different levels of society to build resiliency, one of which is through training and education. The first International Conference on Disaster Preparedness and Management convened in Dhulikhel, Nepal on December 1-3, 2023. It brought together international teaching faculty to help deliver didactic and simulation-based sessions on various topics pertaining to disaster preparedness and management for over 140 Nepali healthcare professionals. This paper focuses on the tabletop exercise-based longitudinal workshop portion of the conference on disaster leadership and communication, delivered by United States-based faculty. It delves into the educational program and curriculum, delivery method, Nepali organizer and US facilitator reflections, and provides recommendations for such future conferences, and adaptation to other settings.

Building the Urban Organizational Capability for Resilience as a Matter of Updating Security Education of Community

Abstract This article intends to emphasize the role that education has in strengthening resilience in the urban environment. It is highlighted how, starting from quantitative and qualitative aspects of some work tools dedicated to resilience, weak points of the materialization stage of the security culture to support a mature level of resilience can be identified. In practice, we can talk about a mutually supportive relationship between the two concepts: a high level of security culture allows, facilitates and augments an organizational behavior that favors resilience in the face of contemporary adversities, and the lessons learned as a result of an experience aimed at resilience adjust and provide feed-back to the security culture. Both macroconcepts have a common vein of support given by the educational component of the characteristic processes. Wanting to be as resilient as possible, against a backdrop of a robust security culture, therefore becomes a matter of preparation and training first and foremost. The research method is exploratory, accompanied by examples of known cases. The convergence of the approach has the purpose of bringing to the attention of stakeholders the usefulness of table top exercises, as a necessary training method for risk awareness and emergency management.

Implementation of a workshop for mass casualty incident triage training using an immersive virtual reality simulation.

We offered a workshop at the 2023 annual meeting of the Society for Academic Emergency Medicine to teach the Sort-Assess-Lifesaving Interventions-Treatment/Transport (SALT) triage protocol for responding to mass casualty incidents (MCIs) using an immersive virtual reality (VR) simulator. Here, we report workshop outcomes. After a 1-h didactic on the basics of triage protocols, workshop participants rotated through three skill stations at which learners learned how to use the VR headset and controllers, practiced applying SALT triage skills through a tabletop exercise, and then finally used our VR simulator for training responses to MCIs. During their encounter with VR, participants applied their new knowledge to triaging and treating the victims of an explosion in a virtual subway station. After a brief orientation, participants entered the scene to treat and triage virtual patients who had various life-threatening (e.g., acute arterial bleed, penetrating injury, pneumothorax, amputations) and non-life-threatening injuries (lacerations, sprains, hysteria, confusion). The simulator generated a performance report for each workshop attendee to be used for debriefing by a skilled facilitator. Participants were mostly trainees (residents), all of whom properly initiated their encounter with global sort commands (walk and wave) to identify the most critically injured. On average, participants correctly treated 92% of 18 injuries, with all bleeding injuries being properly controlled (tourniquets or wound packing). On average, participants correctly tagged 87.7% of 11 patients, but only took the pulse of 67% of the 11 patients. Learners had difficulty with cases involving embedded shrapnel and properly tagging patients who were stable after treatments. Our VR simulator provided a practical, portable, reproducible training and assessment system for preparing future emergency medical systems (EMS) medical directors to teach their EMS professionals the triage and lifesaving intervention treatment skills needed to save lives.

Learning to Lead Through a Trauma-Informed Care Lens: A Tabletop Exercise Exemplar.

Learning to Lead Through a Trauma-Informed Care Lens: A Tabletop Exercise Exemplar.

Projects for queering disaster: reciprocal knowledge exchange and practice

PurposeThe purpose of this study is to identify LGBTQ+ perceptions of and experiences with hazards, vulnerabilities and disasters in the San Francisco Bay Area in the USA and to co-develop applied projects to “queer” disaster knowledge production and risk reduction activities in the region.Design/methodology/approachThis is a community science project in which we collaborate with community members to enhance both community and scientific knowledge with the goal of utilizing it to produce a positive change to pressing social issues and their underlying causes. We do this through a series of four focus group workshops to identify community priorities, hazards, vulnerabilities and local action. We follow this with further ethnographic research and projects to apply findings from phase one.FindingsThe authors have found that: LGBTQ+ people in the Bay Area have unique experiences with hazards, vulnerabilities and disasters; there are significant gaps in the representation of LGBTQ+ hazard exposure in local scientific models that we can address through alternative methodologies; and tabletop exercises, learning modules and podcasts help orient and train disaster response agencies and personnel on LGBTQ+ inclusive operations.Originality/valueThis initiative entails novel approaches to community science for disaster risk reduction and creative collaboration with community-based organizations to foster the development of LGBTQ+ inclusive disaster risk reduction and response.

Natural hazard risk analysis in the framework of water safety plans.

The available literature on natural hazard risk analysis focused on the implementation of water safety plans (WSPs) is surprisingly quite poor, despite the significant increase in the number and severity of disasters and adverse effects on drinking water supply systems generated by natural hazards. At the same time, WSPs that conveniently account for natural hazards with a comprehensive approach 'from source to tap' are still scarce as they typically occur at larger spatial scales and adequate prevention, mitigation and adaptation require efficient inter-institutional collaborations. The aim of this paper is to highlight the main bottlenecks for water utilities to include natural hazards in the development of their WSPs. The research adopted a stakeholders-oriented approach, involving a considerable number of water utilities (168), water sectoral agencies (15) and institutions (68) across the Adriatic-Ionian Region through a stepwise process that generated joint SWOT analysis, the development of a decision support system (DSS) focused on WSPs procedures and tabletop exercises. The final outcomes generated strategic documents (REWAS - Adrion Road map for resilient water supply) that highlighted the necessity for efficient cross-sectoral and inter-institutional cooperation in the development of well-founded and robust WSPs to address natural hazard risk analysis for water supply systems (DWSS).

Learner Perception of Disaster Simulation Modalities: A Pilot Study.

Both simulation and tabletop exercises are used in disaster training, but the efficacy of one approach versus the other is lacking. This pilot study explored the satisfaction, confidence, and perception of effectiveness among nursing students regarding 2 disaster preparedness training methods: simulation and tabletop exercises. A comparative quasi-experimental design assessed the effectiveness of 2 simulation experiences. Validated effectiveness and confidence survey tools were completed by 126 self-selected senior prelicensure baccalaureate nursing students after the completion of simulation experiences. Tabletop exercises may be more effective to build confidence and understand pathophysiology. Full-scale simulations may be more effective in facilitating participant expression of feelings and providing a constructive evaluation of the simulation. Variability among facilitators may have impacted the results of this pilot project. Further research is needed to enhance understanding of the effectiveness of tabletop and full-scale simulations for disaster preparedness in nursing education.

Evacuation modelling for rapid multi-hazard tabletop exercise deployment

To prepare for large-scale emergencies and crisis affecting communities, authorities, and emergency commanders use several types of training methods ranging from seminars to full-scale exercises. Within this continuum of exercise types, tabletop exercises (TTXs) are habitually used to familiarise participants with mitigation strategies, population management and evacuation procedures conducted as a response to natural or technological hazards. Commonly, TTXs are paper-based, and if computerised, use basic electronic maps, tend to be scripted and have a linear nature. Information flow is unidirectional as the script dictates how the exercise unfolds. These exercises have little capacity for producing qualitative or quantitative feedback related to the impact that the received scenario injects (i.e., incoming messages including scripted events and hazard locations), the authorities’ decisions, and the impact of hazards have on the wellbeing of the community and the evacuation process. While informative during training, this type of feedback may prove vital in assessing the likely impact of real incident. In this work an evacuation simulation model is proposed to augment the TTX experience in real time, offering feedback and insights on the impact that such injects, decisions and hazards have on the simulated community.The proposed methodology is utilised in an actual TTX co-organised and executed by the Municipality of Rhodes, Greece, where the evacuation model is used to (a) develop the standard, non-incident specific evacuation procedures for the Medieval City of Rhodes (MCR), (b) to adapt these procedures based on the injects (generated on-site or telecommunicated, emulating receipt from the field), producing the TTX scenario and (c) to provide information on the impact that the TTX hazards have on the evacuation process. The integration of evacuation modelling into the TTX process demonstrated that it is possible to gain a deeper understanding of the complexities related to route choices in response to path closures, the assembly and evacuation performance, as well as the management of the simulated incident by analysing qualitative and quantitative simulation results.

Action‐time‐controlled tabletop gamification improves physician‒nurse collaborative emergency room evacuation training

AbstractThis article is an example of Lessons from the Field highlighting the practical implementation of a novel time‐controlled mechanism in the gamification of emergency department evacuation training via tabletop exercise. Tabletop exercise is one of the most common drill types for disaster preparedness. It is easy to use, effective, and low in cost, but it has some shortcomings. For example, its lack of authenticity is often criticized. We add a time‐control mechanism to the tabletop exercise and use settings similar to real events in an attempt to increase the authenticity of the tabletop exercise and the learning effect. We completed a 3‐h tabletop gamification of emergency room evacuation, which included a time control mechanism. Medical staff in our emergency department were asked to join this tabletop training. We evaluated the effectiveness of the time‐control tabletop exercise through the results of the pretest and posttests and feedback from the participants. A total of 97 emergency medical staff from the Emergency Department of Cheng Kung University Hospital, including 64 nurses, 29 emergency doctors and four nurse practitioners, participated in this tabletop exercise. After experiencing the time‐control tabletop exercise, the participants significantly improved their approach to mass casualty incidents, their method for evacuating patients, and their triage skills. The correct answer rate for the pretest and post‐test rose from 68.75% to 94.33% with statistically significant. The feedback from the participants also showed that the time‐control tabletop exercise was interesting and could increase learning motivation. The time‐control mechanism had a positive impact on the learning effect. It increased the reality of tabletop exercises, promoted participants' learning motivation, and improved their performance on the test.

Review of Israel's action and response during the COVID-19 pandemic and tabletop exercise for the evaluation of readiness and resilience-lessons learned 2020-2021.

Reevaluating response plans is essential to ensuring consistent readiness and resilience to the COVID-19 pandemic. The "During Action Review" and Tabletop (DART) methodology provides a retrospective and prospective assessment to inform the adaptive response. Israel introduced COVID-19 vaccinations in December 2020 and was the first country to implement booster vaccination to address waning immunity and surges caused by new variants. We assessed Israel's readiness and resilience related to COVID-19 response while capturing the pre-vaccination and vaccination periods. A DART analysis was conducted between December 2020 and August 2021 among experts involved in the management of the COVID-19 pandemic in Israel. During the retrospective stage, a role-based questionnaire and discussions were undertaken in a participant-led review of the response, focusing on epidemiology and surveillance, risk communication, and vaccines. The prospective stage included tabletop exercises to evaluate short to long-term simulated scenarios. Participants emphasized the pivotal role of Israel globally by sharing experiences with the pandemic, and vaccination. Perceived strengths included multi-sectoral collaboration between the Ministry of Health, healthcare providers, academia, military, and others, stretching capacities, expanding laboratory workload, and establishing/maintaining surveillance. The vaccine prioritization plan and strong infrastructure, including computerized databases, enabled real-life assessment of vaccine uptake and impact. Challenges included the need to change case definitions early on and insufficient staffing. Quarantine of patients and contacts was particularly challenging among underprivileged communities. Risk communication approaches need to focus more on creating norms in behavior. Trust issues and limited cooperation were noted, especially among ethnic and religious minorities. To ensure readiness and resiliency, participants recommended establishing a nationally deployed system for bringing in and acting upon feedback from the field, especially concerning risk communication and vaccines. Our study appraised strengths and weaknesses of the COVID-19 pandemic response in Israel and led to concrete recommendations for adjusting responses and future similar events. An efficient response comprised multi-sectoral collaboration, policy design, infrastructure, care delivery, and mitigation measures, including vaccines, while risk communication, trust issues, and limited cooperation with minority groups were perceived as areas for action and intervention.

A customized table-top aging simulation exercise to augment gerodontology teaching.

While aging simulation suits have been used in healthcare education to promote empathy for older adults, little has been published on learning outcomes specific to geriatric dental patients. We designed a seminar utilising a customised ageing simulation suit to help dental students empathise with several disabilties their older adult patients may face.

Use of virtual reality exercises in disaster preparedness training: A scoping review.

The scope and number of disasters have increased over the years. This has called for more robust disaster preparedness training and plans. The use of virtual reality exercises in addition to tabletop exercises is considered a new approach to the preparation of disaster preparedness plans. Virtual reality exercises are being developed to either replace or complement current traditional approaches to disaster preparedness training. To review and summarize the current existing literature regarding the effectiveness, advantages and limitations of using virtual reality exercises in disaster preparedness as a complementary/replacement mechanism for real-time drills and tabletop exercises. In this scoping review, we searched PubMed, Cochrane, EMBASE, PLOS, and Google Scholar for research publications involving virtual reality exercises in disaster training from 2008 to 2022 using "AND" and "OR" operators for the keywords "disaster," "preparedness," "virtual reality," and "tabletop." From a total of 333 articles that resulted in our search and were then evaluated by the authors, 55 articles were finally included in this review. Virtual reality exercises are found to be better in the formulation of disaster preparedness plans compared to tabletop exercises. Virtual reality exercises can be used as the primary means of creating a real-life-like experience in disaster preparedness training and proved at least as better complementary to tabletop exercises. Virtual reality exercises have many advantages over traditional real-life or tabletop exercises and are more cost-effective, but some drawbacks are still identified. The advantages of virtual reality exercises are remarkable and underline their benefits and uses versus costs. We highly encourage decision-makers and institutions dealing in disaster preparedness to adopt using virtual reality exercises in training for disaster preparedness.

The Use of Augmented Reality in Tabletop Exercise for Disaster Preparedness Training: A Descriptive Abstract

Abstract Introduction Augmented reality (AR) is a valuable tool in disaster preparedness training such as tabletop exercises that enhances the exercise by overlaying digital information and virtual objects. Objective This study intends to develop an application using AR to be used during the exercise. Methods The data is collected through interviews on the opinions and views of the experts from five main agencies in a disaster response; the National Disaster Management Agency, the Royal Malaysia Police, the Fire and Rescue Department of Malaysia, the Ministry of Health, and the Malaysia Civil Defence Department, discussing their duties during a flood scenario. The consensus achieved after series of interviews with the experts, including document reviews guided by National Security Council Directive 20. Results The AR approach is created through ‘marker-based’ which use an image recognition to build up an engaging ‘storyline’ of flood scenario. It includes the updates on the changing plot during the exercise using an ‘inject’ meant to progress the plot and provide fresh data to evaluate and react to. Discussion Integrating virtual objects and entities into the tabletop exercise is made possible by AR, where it revolutionises how disaster responders being trained using an approach that more engaging and effective.

Effectiveness of a Structured Disaster Management Training Program on Nurses’ Disaster Readiness for Response to Emergencies and Disasters: A Randomized Controlled Trial

Background. Most frontline nurses lack sufficient readiness for effective disaster response. Therefore, designing a disaster management training program (DMTP) to promote nurses’ readiness for disaster response is imperative. Aim. This study aimed to evaluate the effectiveness of a structured DMTP on nurses’ readiness for response to disasters. Methods. A randomized controlled trial was conducted. One hundred eligible nurses, recruited using convenience sampling from a medical centre in northern Taiwan, were randomly assigned to either the experimental (EG, n = 50) or control (CG, n = 50) group. Both groups received regular continuous nursing education. The EG received an extra two‐day (16 h) structured DMTP delivered by transdisciplinary collaborations through multiple teaching strategies (lectures, simulations, problem‐solving lessons, demonstrations, tabletop exercises, discussions, group presentations, and reflections). Readiness for disaster response, consisting of four subscales (emergency response, clinical management, self‐protection, and personal preparation), was assessed at baseline and 12 weeks after the intervention. Generalized estimating equations were used as the primary method of data analyses to evaluate the intervention effects. Results. Ninety‐four nurses (94%) completed the study, and 100 nurses were included in the intention‐to‐treat analysis. While participants in the EG had increased readiness for disaster response after training and at the 12‐week follow‐up, those in the CG exhibited no differences between baseline and 12‐week follow‐up. When the group × time interaction was examined, the EG had a greater increase in readiness for disaster response and its four domains, including emergency response, clinical management, self‐protection, and personal preparedness after 12 weeks, than the CG. Conclusion. A two‐day structured DMTP utilizing multiple teaching strategies through transdisciplinary collaborations is recommended to enhance hospital nurses’ readiness for disaster response. Implications for Nursing Management. Nursing leaders should consider incorporating such a structured DMTP into ongoing nursing training as a critical component of professional development programs, thereby strengthening nurses’ disaster readiness in hospital settings.

Validating Disaster Medicine Experts’ Feedback Outcome Using Artificial Intelligence Computing Techniques

Abstract Objectives This study aimed to use artificial intelligence (AI) computing techniques to determine if they can validate the findings of a previously published thematic analysis article focusing on disaster medicine experts’ open-ended feedback about Middle East and North African countries (MENA) for chemical, biological, radiological, and nuclear (CBRN) threats. Methods Automated text analytics techniques were employed to explore and visualize the semantic essence of the experts’ feedback through word vector transformation and Principal Component Analysis (PCA) for dimensionality reduction. The t-distributed Stochastic Neighbor Embedding (t-SNE) is another more advanced dimensionality reduction technique that enhanced the capturing of the determined components. Results Two prominent clusters emerged from the full textual data set representing word similarities groups in the original data set, denoting a thematic group of ideas that experts have emphasized in their responses. Upon deep reading the text feedback, the themes linked preparedness with different training types, such as tabletop exercises and policies/legislation. The findings are in line with currently adopted practices. Conclusions While AI methods demonstrated their valuable application in disaster medicine and helped validate the experts’ recommendations objectively, they should be approached cautiously, as they can be complex and challenging to comprehend fully.