Tabletop Exercise Research Articles

Influenza outbreak management tabletop exercise for congregate living settings.

We conducted a tabletop exercise on influenza outbreak preparedness that engaged a large group of congregate living settings (CLS), with improvements in self-reported knowledge and readiness. This proactive approach to responding to communicable disease threats has potential to build infection prevention and control capacity beyond COVID-19 in the CLS sector.

MalAware: A tabletop exercise for malware security awareness education and incident response training

Advancements in technology, including the Internet of Things (IoT) revolution, have enabled individuals and businesses to use systems and devices that connect, exchange data, and provide real-time information from far and near. Despite that, this interconnectivity and data sharing between systems and devices over the internet poses security and privacy risks as threat actors can intercept, steal, and use owners’ data for nefarious purposes. This paper discusses ’MalAware’, a ‘Malware Awareness Education’ and incident response (IR) scenario-based tabletop exercise and card game for malware threat mitigation training. It introduces the importance of incident management, highlights the dangers posed by malware for connected systems, and outlines the role of tabletop games and exercises in helping businesses mature their malware incident response capabilities. The study discusses the design of MalAware and summarises the results of 2 pilots undertaken to assess the concept, maintaining that the results highlighted the value of ‘MalAware’ as an essential tool to help students and staff master how to mitigate security threats caused by malware. It argues that MalAware can assist businesses in their IR preparedness endeavors, enabling incident management teams to review plans and processes to ensure they are fit for purpose. It enables staff to leverage scenario-based and simulated security breach examples, including role-play, to establish appropriate malware defences. MalAware’s practical hands-on exercises can assist trainees in gaining essential malware and other threat mitigation skills, helping to protect the security and privacy of IoTs.

Enhancing First Responder Safety in Nuclear Radiological Emergencies: A Systematic Literature Review of Personal Protective Equipment (PPE) Training to Promote Self-Efficacy Among First Responders

Abstract Objective Nuclear radiological emergencies are classified as low frequency, but high impact events. Radiophobia and fear of deleterious outcomes often evokes hesitancy among responders. This review explored PPE use as a protective mechanism for responders’ safety and identified tools that promote PPE efficacy among first responders during nuclear radiological events. Methods A systematic literature review was conducted using five scientific databases. More than 5,500 articles were screened to identify literature relating to “PPE use” by first responders during “nuclear radiological events”. Results Regulatory agencies such as the IAEA and the NRC assert that PPE, (when worn correctly and consistently) minimizes radiation exposure. Adequate training of first responders emerged as a critical determinant to support appropriate PPE selection and usage during radiological emergencies. This included new employee trainings and refresher courses for existing employees. Pedagogical tools highlighted in the literature included tabletop exercises, safety huddles, trial runs for donning and doffing of new gear (with emphasis on air-fed suits), just-in-time training and virtual reality simulations. Conclusions Education on the effective use of PPE is essential to promote self-efficacy among medical staff and other first responders during nuclear radiological events. Comprehensive training will reduce unintended exposures, decrease hesitancy, and maximize employee safety.

Perempuan dalam Penanggulangan Bencana: Peran Perempuan dalam Peningkatan Kesiapsiagaan Melalui Table Top Exercise (TTX)

One of the principles of disaster management in Law Number 24 of 2007 concerning Disaster Management is non-discrimination, towards gender, ethnicity, religion, race and any political sect. This principle applies at every stage of disaster management, both pre-, emergency and post-disaster. In its development, the role of disaster management cannot be generalized to just one group. Gender mainstreaming is one of the strategies adopted so that the principle of non-discrimination can work well. Efforts to apply these principles are carried out in Tabletop Exercise (TTX) preparedness training activities which are carried out for socialization, to provide an understanding of policies, procedures, plans that have been prepared, will be prepared or need to be prepared. It is hoped that the role of women in TTX can provide a more specific perspective regarding the needs and roles that can be filled by women in disaster management. Although the number of female personnel involved in TTX is limited, if they hold key positions they can provide significant results in the implementation of TTX.

A Call to Action: Why Anesthesiologists Must Train, Prepare, and Be at the Forefront of Disaster Response for Mass Casualty Incidents.

Disasters, both natural and man-made, continue to increase. In Spring 2023, a 3-hour workshop on mass casualty incidents was conducted at the Society for Pediatric Anesthesia-American Academy of Pediatrics Annual conference. The workshop used multiple instructional strategies to maximize knowledge transfer and learner engagement including minididactic sessions, problem-based learning discussions in 3 tabletop exercises, and 2 30-minute disaster scenarios with actors in a simulated hospital environment. Three themes became evident: (1) disasters will continue to impact hospitals and preparation is imperative, (2) anesthesiologists are extensively and comprehensively trained and their value is often underestimated as mass casualty incident responders, and (3) a need exists for longitudinal disaster preparedness education and training over the course of a career. In this special article, we have sought to further define the problem and evidence, the capacity of anesthesiologists as leaders in disaster preparedness, and the rationale for preparation with current best practices to guide how best to move forward.

Insights from Evidence-Based Medicine Method for Building Security Systems Against Terrorist Attacks in Hospitals.

Hospitals have become soft targets for terrorism, with increasing terrorist attacks observed in the last two decades. Not only the counter-terrorism and law enforcement agencies but the hospitals also need to be actively involved and undertake the responsibility of safeguarding hospital security by establishing an effective security system. Evidence-based medicine emphasizes the significance of scientific evidence, and in practice, research methods for the generation, collection, and utilization of evidence may offer new insights to overcome the issue of terrorism. The present study discusses the potential application of methods in evidence-based medicine for developing security systems against terrorist attacks in hospitals. First, hospitals can use simulated scenarios of terrorist attacks to generate evidence. For example, combining virtual technology with virtual reality technology and selecting appropriate algorithms or models to generate evidence. Second, they can apply tabletop exercises to propose measures, as a means of collecting evidence. The collection of data can be obtained through questionnaires or interviews. Some biological methods, such as collecting salivary markers of acute stress (α-amylase and secretory immunoglobulin A), can also be used to assess emotional states. Third, they can use the collected evidence to practically test and refine the implemented measures. To verify the effectiveness and feasibility of the formulated solutions in real-life scenarios, simulations, models, drills, and similar methods can be used. This approach may provide new perspectives for the development of hospital security systems.

Exercise design for interagency collaboration training: The case of maritime nuclear emergency management tabletop exercises

AbstractIn this paper, we explore a concept of exercise design within emergency management competence development. The paper presents recommendations for exercise design aspects that may be suitable for gaining collaboration skills and knowledge that responders need in unknown events of high complexity. This study explores the practice of tabletop exercises with complex scenarios that engage participants to discover organizational roles and responsibility division in collaborative action. Empirically, we base our analysis on maritime search and rescue nuclear preparedness exercises in the Arctic seas. We focus on elements that are essential for learners to increase their knowledge of operational complexity and collaborative performance, including understanding one's own and others' roles and responsibilities, formation of interagency teams, their boundaries and interaction between authorities and levels, mutual recognition of risks and learning about resource capacities and their limitations. The study draws conclusions on aspects that are critical for designing emergency management tabletop exercises, in particularly discussions in mixed groups for interpretative learning; own practice reflection for integrative learning; formulating general collaborative competence objectives, and complexity and realism of scenarios.

Intersectoral collaboration in a One Health approach: Lessons learned from a country-level simulation exercise

Intersectoral collaboration is an essential component of the One Health (OH) approach, which recognises the interconnectedness of the health of humans, animals, and the environment. The OH European Joint Programme (OHEJP) developed a national foodborne outbreak table-top simulation exercise (SimEx) to practice OH capacity and interoperability across the public health, animal health, and food safety sectors, improving OH preparedness for future disease outbreaks. The Portuguese OHEJP SimEx highlighted strengths and weaknesses regarding the roles and functions of available systems, the constraints of existing legislation, the importance of harmonisation and data sharing, and the creation of common main messages adapted to each target sector. However, there is still a long way to go to ensure cooperation among the Public Health, Animal Health, and Food Safety sectors, as a OH approach relies not only on the awareness of “field experts” but also on political and organisational willingness and commitment.

A43MAGIC – the management of acute emergencies in GP surgeries using <i>in situ</i> simulation and checklists, project final phase: completed quick reference handbook and plans for sustainability

GP teams manage a wide spectrum of acutely unwell and deteriorating patients, these are unexpected, high risk, low frequency events. Ambulance delays mean patients may need prolonged input prior to transfer. There is little best practice guidance for many emergencies seen in primary care. Evidence from secondary care shows improved non-technical skills when checklists are used in emergency simulations. We have previously presented early phases of the MAGIC project to design a Quick Reference Handbook (QRH) for GP teams and now present the final handbook along with plans for embedding it in primary care. Previous presentations at scientific conferences (ASPiH) covered the Delphi process used to develop the QRH and the pilot training programme incorporating in-situ simulation. We incorporated feedback from 14 GP teams who used the checklists in the context of in situ simulations and used a round of tabletop simulations at six GP practices to finalize the checklists in the handbook. The development process was guided by the ‘CLEAR’ principles proposed by Greig et al [1] and the design of the QRH for anaesthetic emergencies [2] which followed human factors principles. Since completing the GP QRH we have been focusing on plans for sustainability. The QRH will be incorporated into in situ simulation or tabletop exercises [3]. We have written standardized ‘MiniSim’ scenarios using low fidelity techniques and accompanied by the relevant checklist. They will be uploaded on the iRIS platform to ensure ease of access. We are working with colleagues in GP training hubs around the HEE South-East and South-West regions to embed the QRH and then share the work nationally. We have completed a GP QRH including 16 checklists: fourteen to guide clinical actions in acute conditions ( An example of a checklist from the GP quick reference handbook Checklists improve non-technical skills and team performance in emergency situations. We have developed the world’s first GP QRH to support safer care of emergencies in primary care. The GP QRH will be freely available together with training materials to embed it in practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Map functions to facilitate situational awareness during emergency events

ABSTRACT Emergency events such as floods and wildfires are handled by various responders and at various levels: strategic, tactical, and operational. To facilitate situational awareness, emergency responders require customized map-based decision support systems that are tailored to specific needs depending on the responders’ organizational affiliation, role, objectives, and occupationally specific knowledge. As a result, the systems are equipped with manifold map functions. However, the diversity of map-based emergency tools in use impedes gaining common user skills among their target audiences and thus, requires a systematic overview. Through a multistep research process, this study was to: investigate the requirements for support from map-based tools expressed by various emergency responders in Norway, identify desired map functions, and categorize those functions to facilitate an overview. Six stages constituted our workflow: meetings with Norwegian emergency responders, survey on selected map-based tools, interviews with designers and users of tools, a table-top exercise, theoretical considerations, and validation with stakeholders. This study contributes to the state of the art by systematizing and structuring knowledge about map functions that facilitate situational awareness. In turn, it helps developing and optimizing functionality of map-based tools depending on needs of specific emergency responders.

Enhancing Disaster Resilience: Evaluating the Implementation of an Early Warning System through Table Top Exercises

This research investigates the periodic implementation of an Early Warning System (EWS) using the Table Top Exercise (TTX) method to assess its effectiveness in enhancing community preparedness for disasters. Specifically, it analyzes the utilization of the Early Warning System as a disaster communication medium through the Table Top Exercise method and identifies challenges faced within the Disaster Risk Reduction Forum in Gung Pinto Village, Kec. Namanteran District, Karo. The study focuses on the People-Centered Early Warning System and the incorporation of Local Wisdom in the Early Warning System. The research employs the Knowledge Construction Theory as its theoretical framework. Data is gathered through interviews, observations, and document analysis, with qualitative analysis methods applied. The study concludes that the implementation of an Early Warning System (EWS) can significantly mitigate risks and safeguard communities against disaster impacts. Additionally, it highlights challenges such as limited information accessibility, resource constraints, and time limitations in the process.

Extensible VR Emergency Preparedness Platform

Emergency preparedness is a cardinal skill required in today's fragile world. Conventionally, individuals acquire knowledge of procedures that they are required to take during an emergency situation through a regimen of training-drills, tabletop exercises, functional exercises and full-scale exercises. These procedures are usually far from reality as these are structured training schedules happening in a utopian environment. To bridge this gap, we developed a generic virtual learning framework. This framework is extensible across multiple scenarios and locations. The proposed platform can complement the conventional emergency training methods to enhance the overall emergency preparedness of private organizations (e.g. workplaces, commercial buildings, etc.) and also indirectly benefit wider communities.

RAD-XP: Tabletop Exercises for Eliciting Resilience Requirements for Sociotechnical Systems

Despite noble intentions, new technologies may have adverse effects on the resilience of the sociotechnical systems into which they are integrated. Our objective was to develop a lightweight method to elicit requirements that, if implemented, would support sociotechnical system resilience. We developed and piloted the Resilience-Aware Development Exercise Protocol (RAD-XP), a method to generate tabletop exercises (TTXs) to elicit resilience requirements. In the pilot study, this approach generated 15 requirements from a one-hour TTX, where the majority of requirements were found to support resilience. Participants indicated via survey that RAD-XP was effective and efficient, and that they would want to use RAD-XP regularly throughout the agile development process. We discuss future research and development to refine this approach to eliciting resilience requirements.

Resilience against IT attacks in hospitals : Results from an exercise in aGerman university hospital

According to the legal definition healthcare systems and their components (e.g., hospitals) are part of the critical infrastructure of modern industrial nations. During the last few years hospitals increasingly became targets of cyber attacks causing severe impairment of their operability for weeks or even months. According to the German federal strategy for protection of critical infrastructures (KRITIS strategy), hospitals are obligated to take precautions against potential cyber attacks or other IT incidents. This article describes the process of planning, execution and results of an advanced table-top exercise which took place in a university hospital in Germany and simulated the first 3 days after acyber attack causing atotal failure of highly critical IT systems. During afirst stage lasting about 8 months IT-dependent processes within the clinical routine were identified and analyzed. Then paper-based and off-line back-up processes and workarounds were developed and department-specific emergency plans were defined. Finally, selected central facilities such as pharmacy, laboratory, radiology, IT and the hospitals crisis management team took part in the actual disaster exercise. Afterwards the participants were asked to evaluate the exercise and the hospitals cyber security using aquestionnaire. On this basis the authors visualized the hospital's resilience against cyber incidents and defined short-term, medium-term and long-term needs for action. Of the participants 85% assessed the exercise as beneficial, 97% indicated that they received adequate support during the preparations and 75% had received sufficient information; however, only 34% had the opinion that the hospital's and their own preparedness against critical IT failures were sufficient. Before the exercise took place, IT-specific emergency plans were present only in 1.7% of the hospital facilities but after the exercise in 86.7% of the clinical and technical departments. The highest resilience against cyber attacks was not surprisingly reported by facilities that still work routinely with paper-based or off-line processes, the IT department showed the lowest resilience as it would come to acomplete shutdown in cases of atotal IT failure. The authors concluded that the planning phase is the most important stage of developing the whole exercise, giving the best opportunity for working out fallback levels and workarounds and through this strengthen the hospitals resilience against cyber attacks and comparable incidents. Ameticulous preparedness can minimize the severe effects atotal IT failure can cause on patient care, staff and the hospital as awhole.

Assessing the pharmacy workforce's preparedness for a workplace violence event.

The purpose of this article is to describe the planning, implementation, and findings of a "person with a weapon" exercise for an inpatient pharmacy department. There has been an increased focus on workplace violence in healthcare within the last few years. The health-system pharmacy workforce should take an active role in planning for workplace violence events by completing a risk assessment analysis and performing tabletop and functional exercises. This study provides an example of how health-system pharmacists collaborated with an emergency management team, security, and communications to carry out a person with a weapon exercise in an inpatient hospital pharmacy. Areas for improvement were identified for pharmacy, communications, and security during education sessions and the tabletop and functional exercises, demonstrating the importance of a multidisciplinary approach when planning for a person with a weapon event. As a result of this exercise, there was increased awareness of the "run, hide, fight" tactic, an increase in workplace violence education and staff awareness, and an enhancement of security measures, including technology improvements. This workplace violence exercise provides an example of how the pharmacy workforce can engage in emergency preparedness planning and risk mitigation for a workplace violence event. Other health systems can use the action plan, findings, and improvements to raise awareness and train about workplace violence events and support the safety of the pharmacy workforce.

The Value of Wargames and Tabletop Exercises as Naturalistic Tools

Wargames and tabletop exercises (TTXs) have existed for centuries in military planning contexts but have seen relatively limited use as methods of inquiry within the human factors community of practice. We argue that that the use of these tools is not commensurate with their value, as they are effective and efficient means to conduct naturalistic inquiry. We demonstrate the value of wargames and TTXs by presenting two case studies of their use in different domains, highlighting how their outputs were used to achieve research objectives and to glean insights about human cognition in the context of work. We also discuss the similarity of wargames and TTXs to other methods of inquiry, and suggest future areas for research.

Effect of a Tabletop Program for Training Emerging Infectious Disease Responses in Nurses at Small- to Medium-Sized Hospitals in Areas with Poor Healthcare Access.

This study developed and evaluated a tabletop program for training nurses working in small- to medium-sized hospitals in areas with poor healthcare access for emerging a tabletop program for training emerging infectious disease responses in nurses working at small- to medium-sized hospitals in areas with poor healthcare access and evaluated infectious disease responses. A tabletop program for training responses to emerging infectious diseases was provided to 29 nurses at a general hospital with <300 beds in a region without a tertiary general hospital or healthcare institution with nationally designated inpatient wards for patients with infectious diseases. The 180 min program consisted of an online theoretical lecture (Phase 1), one-on-one drills (Phase 2), and a scenario-based tabletop exercise (Phase 3). To evaluate the program's effect, pre- and post-knowledge, awareness, and competencies related to responses to emerging infectious diseases were assessed. The mean knowledge score significantly improved from 11.41 ± 2.33 before the training to 16.69 ± 2.48 after the training (z = -4.529, p < 0.001). The mean awareness score significantly improved from 80.83 ± 11.94 before the training to 85.45 ± 7.08 after the training (z = -2.335, p = 0.020). The mean competence score significantly increased from 67.31 ± 14.75 before the training to 79.38 ± 10.39 after the training (t = -6.187, p < 0.001). The tabletop exercise program effectively enhanced the nurses' competencies in responding to emerging infectious diseases. The training program developed in this study may be utilized in addition to a simplified theoretical lecture to train nurses to improve their competency in responding to emerging infectious diseases.

Comparing the effectiveness of board game-based and drill-based education programs in improving Taiwanese nurses' fire safety knowledge, attitudes, and behavior: A quasi-experimental study

BackgroundFire education is currently dominated by drill-based programs, however only a limited number of participants may take part in fire drills. This gap could be addressed by the development of innovative board game-based educational programs. ObjectiveThis study sought to compare the effectiveness of board game-based and drill-based fire safety education programs in improving nurses' fire safety knowledge, attitudes, and behavior. MethodsIn this quasi-experimental study, 122 nurses were purposively sampled from a hospital in southern Taiwan. The participants were divided into two groups based on their willingness. Sixty-two nurses in the game-based group took part in an hour-long educational board game for fire safety; and 60 in the drill-based group took part in an hour-long fire drill organized by the hospital. The participants' pre- (T0) and post-intervention (T1) questionnaire scores on fire safety knowledge, attitudes, and behavior were recorded. The statistical methods included descriptive statistics and t-tests. ResultsAfter the interventions, both groups had improved safety knowledge, attitudes, and behavior. However, from T0 to T1, only fire safety knowledge was significantly higher in the game-based group than in the drill-based group, and there were no significant differences in fire safety attitudes and behavior between the two groups. ConclusionsA board game-based fire education program is similar to a tabletop exercise, and drill-based programs more accurately reflect actual circumstances. Both methods can be applied based on the educational objectives and actual educational settings. The results of this study may function as a reference for designing clinical, educational, and academic interventions for fire safety in healthcare settings.

Assessment of performance during cybersecurity tabletop exercises

Assessment of performance during cybersecurity tabletop exercises

Planning a large‐scale tabletop exercise to test Qatar's healthcare system readiness to respond to a major incident during the 2022 FIFA World Cup

AbstractThis article is an illustration of ‘Lessons from the Field’. The Journal of Contingencies and Crisis Management has begun to present lessons coming from professionals engaged in crisis management. ‘Lessons for the Field’ provides insights that can be useful to other professionals. Moreover, ‘Lessons from the Field’ can stimulate ideas for researchers and provide resources for educators. Hosting a mega‐sporting event such as the International Federation of Football Associations (FIFA) World Cup presents many healthcare challenges, especially when organized over a small geographical area with many international supporters potentially increasing the country's normal population by 50%. This article presents how a system‐wide tabletop simulation exercise was planned to test Qatar's healthcare system's readiness to respond to a potential major incident during the FIFA World Cup. The healthcare system‐wide tabletop exercise lasted about 4 h with participants engaging in all the various facilities as expected. It provided opportunities for everyone to put their knowledge of major incident response and mass casualty management into practice. The exercise preparation ensured it ran smoothly for all participants who quickly understood how to engage in the activity. It enabled organizers and participants to identify potential gaps in systems and processes, but also in their own ability to manage such situation.