Tabletop Exercise Research Articles

Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context

This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills, self-confidence, and ability in team building within trans-professional groups in the second scenario, which in concordance with the integration theory, was due to the attempts made in the first scenario. Additionally, there was an improvement in the team’s maturity, which in concordance with the maturity theory, was due to the knowledge and practical skills during scenario plays. These results indicate the importance of continuous tabletop training, and the use of CSCATTT as a collaborative instrument, to promote the development of collaboration and to test the concept of preparedness.

IMPACT OF COVID-19 ON PRIVATE RETIREMENT SAVINGS IN SERBIA

: The outbreak of the COVID-19 pandemic and the related economic downturn have impacted retirement savings, retirement saving schemes, providers, regulators and supervisors, potentially leading to future lower incomes during retirement and significant dysfunctions in the market. The main goal of this paper is to investigate how key indicators of the voluntary pension funds market in the Republic of Serbia were influenced by the Pandemic. The Pandemic certainly had an important effect, and we all had the opportunity to learn first-hand that low frequency high severity events do happen, so they are not only scenarios for a tabletop exercise for something that we should expect but something we need to be prepared for. This goal will be achieved using secondary data such as the data offered by the National Bank of Serbia, OECD Directorate for Financial and Enterprise Affairs, etc. Finally, this paper will present a comparative analysis of the effects of the pandemic on the market of voluntary pension funds in the Republic of Serbia and OECD member countries.

Impact of Virtual Interprofessional COVID-19 disaster simulation Tabletop Exercise (VICTEr) workshop on Disaster Preparedness among interprofessional trainees in a tertiary care teaching hospital in India

INTRODUCTION: Disaster planning is of significant importance for the healthcare professional and the healthcare setting. Hospital-based disaster protocols form the cornerstone of disaster response. There is a paucity of data on disaster preparedness training using the virtual tabletop exercise (VTTX) module for interprofessional education from in-hospital and prehospital settings. With the coronavirus disease 2019 (COVID-19) pandemic, we have seen a paradigm shift of education strategies to the virtual realm. Here we attempt to study the impact of an online tabletop exercise workshop on the knowledge and confidence of disaster preparedness among Interprofessional trainees. MATERIAL AND METHODS: Interprofessional trainees from medical, dental, nursing, respiratory therapy, and paramedic domains who consented were included in this study. Institutional ethics committee approval was received and the study was registered with the clinical trials registry India (CTRI), before initiation. The VTTX module has been adapted from the World Health Organization (WHO) COVID-19 training resources. Three international experts from the disaster medicine domain validated the module, questionnaire, and feedback. Wilcoxon signed-rank test was used to compare the parameters (Knowledge and confidence level) pre and post-workshop. RESULTS: A total of 76 candidates with a mean age was 21.67 ± 2.5 (range:19–36) were part of the workshop. Comparison of the median scores and interquartile range of confidence level and knowledge respectively before [38 (29.25–45.75), 9 (7–11)] and after [51.50 (45–60), 11 (10–12)] the workshop showed vital significance (p-value < 0.001). All participants gave positive feedback on the workshop meeting the objectives. The majority agreed that the workshop improved their self-preparedness (90%) and felt that the online platform was appropriate (97.5%). CONCLUSIONS: This study sheds light on the positive impact of the online VTTX based workshop on disaster preparedness training among interprofessional trainees. Disaster preparedness training using available online platforms may be effectively executed with the VICTEr workshop even during the COVID-19 pandemic. The VICTEr workshop serves as a primer for developing online modules for effective pandemic preparedness training in interprofessional education.

Evaluation of the decision-making process within the table-top exercise of the Terror and Disaster Surgical Care (TDSC®) course

PurposeThe threat of terror is omnipresent in Europe and the number of attacks worldwide is increasing. The target of attacks in Europe is usually the civilian population. Incalculable dangerous situations at the scene of the event and severe injury patterns such as complex gunshot and explosion injuries with a high number of highly life-threatening people present rescue forces, emergency physicians and subsequently hospitals with medical, organizational as well as tactical and strategic challenges. The Terror and Disaster Surgical Care (TDSC®) course trains clinical decision-makers to meet these challenges of a TerrorMASCAL in the first 24–48 h.MethodsA table-top exercise was developed for the TDSC® course as a decision training tool, which was prospectively evaluated in six courses. The evaluation took place in 3 courses of the version 1.0, in 3 courses in the further developed version 2.0 to different target values like, e.g., the accuracy of the in-hospital triage. Furthermore, 16 TDSC® course instructors were evaluated.ResultsFor the evaluation, n = 360 patient charts for version 1.0 and n = 369 for version 2.0 could be evaluated. Overall, the table-top exercise was found to be suitable for training of internal clinical decision makers. Version 2.0 was also able to depict the action and decision-making paths in a stable and valid manner compared to the previous version 1.0. The evaluation of the instructors also confirmed the further value and improvement of version 2.0.ConclusionWith this prospective study, the table-top exercise of the TDSC® course was tested for decision stability and consistency of the participants’ decision paths. This could be proven for the selected target variables, it further showed an improvement of the training situation. A further development of the table-top exercise, in particular also using digital modules, will allow a further optimization.http://www.bundeswehrkrankenhaus-ulm.de

The role of pandemic planning in the management of COVID-19 in England from an infection prevention and control perspective: results of a national survey

ObjectivesThis national survey aimed to explore how existing pandemic preparedness plans (PPP) accounted for the demands placed on infection prevention and control (IPC) services in acute and community settings in England during the first wave of the COVID-19 pandemic. Study designThis was a cross-sectional survey of IPC leaders working within National Health Service Trusts or clinical commissioning groups/integrated care systems in England. MethodsThe survey questions related to organisational COVID-19 preparedness pre-pandemic and the response provided during the first wave of the pandemic (January to July 2020). The survey ran from September to November 2021, and participation was voluntary. ResultsIn total, 50 organisations responded. Seventy-one percent (n = 34/48) reported having a current PPP in December 2019, with 81% (n = 21/26) indicating their plan was updated within the previous 3 years. Around half of IPC teams were involved in previous testing of these plans via internal and multi-agency tabletop exercises. Successful aspects of pandemic planning were identified as command structures, clear channels of communication, COVID-19 testing, and patient pathways. Key deficiencies were lack of personal protective equipment, difficulties with fit testing, keeping up to date with guidance, and insufficient staffing. ConclusionsPandemic plans need to consider the capability and capacity of IPC services to ensure they can contribute their critical knowledge and expertise to the pandemic response. This survey provides a detailed evaluation of how IPC services were impacted during the first wave of the pandemic and identifies key areas, which need to be included in future PPP to better manage the impact on IPC services.

Perception of wildfire behaviour potential among Swedish incident commanders, and their fire suppression tactics revealed through tabletop exercises

Background Swedish wildfires are handled by multipurpose municipal rescue services, raising questions about how non-specialist incident commanders (ICs) perceive and interpret wildfire behaviour. Aims Elucidating ICs’ interpretations of fire behaviour, fuel complexes, weather, landscape structure and the role of these in tactical decisions. Methods We exposed Swedish ICs to questionnaires and tabletop exercises for different standardised fire scenarios. Key results Despite minimal formal wildfire training, ICs showed reasonable consensus in rating of fuels, fire behaviour, hose-lay production rates, etc. Tactics were to access the fire from the nearest road with hose-line laid from the engine and water ferried on trucks. In a scenario where initial attack failed, they typically fell back to roads, without burning off. This indicates a fundamental flaw in tactics employed for high-intensity fires, which easily breach forestry roads, and invite outflanking. Conclusions The IC wildfire knowledge is built on personal and group experience rather than formal education. We found reasonable competence, despite the organisations being designed primarily for other purposes. However, tactical understanding of complex, large incidents was poor. IC training should emphasise potential hazards of such incidents to enhance group competence despite their low frequency. Implications Standardised tabletop exercises can provide insight into decision-making of ICs that is otherwise hidden.

Looking Ahead in the Rearview Mirror: During Action Review and Tabletop (DART) to Strengthen Health Emergency Readiness and Resiliency.

During health emergencies, such as the COVID-19 pandemic, systematic evaluation of capabilities, and multisector coordination are challenging while operating in triage mode. During Action Review and Tabletop (DART) identifies recommendations for strengthening readiness and resiliency by creating a single methodology integrating retrospective analysis of the response to date with a prospective analysis of future scenarios. DART utilizes a role-based questionnaire and participant-led discussion for retrospective response review and identification of future scenarios of concern. Tabletop exercises exploring those future scenarios are conducted in a multi-role format to assess readiness and resiliency. Participants evaluate findings to determine recommended actions to improve response capabilities. 3 COVID-19 focused DARTs demonstrated the ability of this participant-led approach to systematically assess, not only readiness for today, but also resiliency to future complications. While demonstrating its usefulness during COVID-19, DART's flexible and modular design promises to be an effective for any ongoing health emergency.

Educational Opportunities Provided by the Existence of Critical Infrastructures at the Level of Sibiu County in the Field of Training for Resilience

Abstract This article intends to bring to the attention of specialists and the general public alike contemporary educational methods to be applied in training for the awareness and internalization of values specific to the field of societal resilience, with critical infrastructures as the central framework of approach, with their main characteristics related to the fragility of the state of security. The article has a concrete practical value due to its applicability at the level of a centrally located county in Romania. The main infrastructures with critical value for determining potential disruptive events are mapped using specialized software, followed by the presentation of some institutions necessary to be involved for implementation of table-top exercises and, in conjunction or separately, field study trips. As a central point of the research methodology, recent literature highlights are emphasized, which robustly materialize and contextualize the practical approaches presented.

The educational outcomes of an online pilot workshop in CBRNe emergencies

Background: In the past 20 years, humanity, particularly in the Middle East, has experienced three outbreaks of coronavirus disease, restricting our ordinary activities. In addition to the growing risk of chemical, biological, radiological, nuclear, and explosive incidents, discussing an alternative to the usual refresher or first-time face-to-face disaster preparedness education is necessary. This study aimed to evaluate the participants’ educational outcomes following their participation in the “HazMat/CBRNe in the context of mass gatherings” online pilot workshop, which used PowerPoint® presentations, a remotely facilitated tabletop exercise, and videos. Methods and Analysis: This was a retrospective quantitative analysis study based on the participants’ pre- and post-workshop session 1 multiple choice assessment scores and their evaluation results. Results: Although it was based on a small number of participants, the implemented workshop helped accomplish the participants’ educational outcomes. Conclusion: This study demonstrated that this online workshop helped fulfil the participants’ educational needs and familiarize them with the concept of readiness and preparedness for CBRNe threats in mass gatherings; hence, it should be conducted again for other participants. The increasing worldwide use of CBRN agents in industries and bioterrorism heightens the need to ensure appropriate healthcare workers’ readiness through practical, innovative continuous professional development tools in times of pandemics.

MAD* Beyond Defence

Advancements in technology are regularly identified, assessed, and classed into emerging and/or potentially disruptive technologies, according to their ability to cause disruptions to defence systems, and in defence. Perhaps this is because defence capabilities centre on grand technology systems deployed at the level of nations. Hypersonic missiles are one example. The testing of a new hypersonic missile or a research program on types of hypersonic drones immediately sparks questions like: which other nations have such capability? or what types of technologies can be used to detect or counter these? In contrast, the ability to identify weak, faint factors that add up and lead to conflict are not brought together in a systematic manner. Nor is it common for there to be a cross-talk between a combination of methods used within military science and technology organizations over in to social sciences related to intelligence and/or conflict. This is a preventable strategic foresight issue relevant for enhancing, planning for, and investing in the security space. This paper describes the MAD (Methodology for Assessing Disruptions) tool, which is adaptable beyond the defence domain. MAD is a scenario-based two-part table-top exercise conducted to identify weak signals that have the potential to cause disruptions, which by consequence may coalesce into challenges for security. Exercising such methods is essential for security professionals to prepare and plan for future conflicts instead of constantly reacting to immediate acute problems.

Benefits of a collaborative approach to service evaluation in urgent care.

Collaboration and service evaluation are essential enablers for improving models of health and social care. Significant benefits can be achieved when they are combined to form a collaborative service evaluation, particularly when such collaboration involves different clinical professions. This article uses the NHS 111 Wales service to explore a simple example of collaborative service evaluation and to discuss the benefits and challenges identified. While the tabletop exercises described were expected to focus solely on compliance data and the reasons for non-compliance, broader learning was identified for all parties involved. It became clear that there was a lack of shared understanding of each service, and that there were opportunities for education and opportunities to develop new national pathways. It is hoped that readers may be able to compare, learn and possibly replicate the collaborative approach used in their practice settings to achieve similar outcomes.

The engagement of informal volunteers in disaster management in Europe

Informal volunteering is increasingly important in disaster management, but authorities remain cautious about collaborating with informal volunteers. Relatively little is known about the extent to which informal volunteers are integrated into European disaster management systems. We try to remedy this gap by examining Germany, Italy, Belgium, Hungary, Sweden, Norway, Finland, and Estonia, focusing on (1) the policies and institutional arrangements for integrating informal volunteers, (2) the methods and tools used for their engagement, and (3) the presumed benefits and challenges of involving volunteers in disaster management. 95 expert interviews combined with desk research and four online table-top exercises in 2019–2020 involving analysis of 11 disaster cases show that disaster management systems in these countries are taking modest steps toward opening traditional command-and-control structures to informal volunteers. In Sweden and Norway, where volunteering is more common, the engagement of informal volunteers is somewhat regulated, providing an opportunity to formally insure them. In Belgium and Italy, the engagement of informal volunteers is not encouraged, but formal volunteering is encouraged. In Germany, Hungary, Finland, and Estonia, it is done on an ad hoc basis. In most of the countries studied, campaigns to raise volunteers’ awareness of support possibilities are backed up by practical training that focuses primarily on first aid. In all countries, except Germany, social media has been used by disaster management authorities to inform, guide, or register informal volunteers on an ad hoc basis. The studied cases indicate that disaster response is more efficient when procedures for informal volunteer engagement exist.

Investigation of the Receiving United States National Disaster Medical System (NDMS) Disaster Medical Assistant Team (DMAT) in Japan: Development of Standard Operation Procedures for Receiving International Medical Teams

Background/Introduction:Japan DMAT and US DMAT have been collaborating in the past to prepare for expected and unexpected disasters in Japan. Japan is predicting overwhelming disasters on Japanese soil soon, which needs efficient and optimum use of resources in medical assistance, including additional support from overseas, particularly from the US. The Japanese government established a large-scale Earthquake/Tsunami Disaster Emergency Response protocol in 2020. However, this protocol does not include any standard operation procedure (SOP) to receive an international medical team.Objectives:Establishing the SOP of receiving medical assistance from US-DMAT based on the WHO International Emergency Team (EMT) initiative.Method/Description:Collaborated with the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the United States Health and Human Services, tabletop exercises assuming that a large-scale earthquake occurred during hosting the 2025 Osaka Expo was conducted online meeting system.Results/Outcomes:Provisional SOP was formed by the Japan research team and ASPR representatives. Even though Japan had several disaster medical assistance collaborations with US DMAT and is well-familiarized with the Classification and Minimum Standards for Emergency Medical Teams, many issues need to be prepared to accept US DMAT.Conclusion:Numerous procedures need to be conducted to receive US DMAT assistance during a large-scale earthquake in Japan. With this SOP, receiving US medical team assistance will be conducted promptly, eventually saving many lives. This SOP can be modified for other international teams’ acceptance in Japan. It could reference other countries seeking to have SOPs for receiving international medical team assistance in the near future.

Developing a Radiation-Savvy Public Health Workforce.

In 2016 the United States Centers for Disease Control and Prevention (CDC) established a Nuclear/Radiological Training and Exercise Preparedness (TEP) Program to better prepare its workforce to respond to a nuclear/radiological incident. The TEP program is comprised of staff across CDC programs with a variety of specialties such as epidemiologists, clinicians, data managers, communicators, environmental health specialists, at risk population specialists and health physicists. Key TEP activities include the preparation of the CDC Nuclear/Radiological Incident Response and Recovery Annex that describes CDC's roles and responsibilities in the event of a nuclear/radiological incident; establishment of an Incident Management System (IMS) structure to reflect an agency-wide response consistent with CDC's All Hazards Plan; and completion of nuclear/radiological public health preparedness and response training and exercises. In addition to training sessions on the various radiation topics, the TEP program includes seminars on the various roles and responsibilities of the task forces defined in IMS during a response. The TEP program includes a range of discussion-based (seminars, workshops, tabletop exercises) and operations-based (drills and functional exercises) activities aimed at enhancing IMS staff capabilities and capacity to be prepared to respond to a nuclear/radiological incident. In summary, the CDC's Nuclear/Radiological TEP Program prepares knowledgeable, well-trained staff, or a radiation-savvy workforce, ready for a robust response to a nuclear/radiological emergency.

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic.

Humans interact with virus-infected animal hosts, travel globally, and maintain social networks that allow for novel viruses to emerge and develop pandemic potential. There are key lessons-learned from the coronavirus diseases 2019 (COVID-19) pandemic that blood operators can apply to the next pandemic. Warning signals to the COVID-19 pandemic included outbreaks of Severe acute respiratory syndrome-related coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome-related coronavirus (MERS-CoV) in the prior two decades. It will be critical to quickly determine whether there is a risk of blood-borne transmission of a new pandemic virus. Prior to the next pandemic blood operators should be prepared for changes in activities, policies, and procedures at all levels of the organization. Blood operators can utilize “Plan-Do-Study-Act” cycles spanning from: vigilance for emerging viruses, surveillance activities and studies, operational continuity, donor engagement and trust, and laboratory testing if required. Occupational health and donor safety issues will be key areas of focus even if the next pandemic virus is not transfusion transmitted. Blood operators may also be requested to engage in new activities such as the development of therapeutics or supporting public health surveillance activities. Activities such as scenario development, tabletop exercises, and drills will allow blood operators to prepare for the unknowns of the next pandemic.

Crisis Preparedness Exercise on Rift Valley Fever Introduction into Europe under a One Health Approach.

Crisis preparedness training programmes are substantial for the effective management of contingency plans. Rift Valley Fever (RVF) was chosen as the vector transmitted zoonosis for a crisis preparedness exercise co-organised in 2021 by the European Food Safety Authority (EFSA) and the Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “G. Caporale” (IZS-Teramo). The online table-top simulation exercise was planned to strengthen the network of Mediterranean countries on rapid risk assessment, risk/crisis management and risk communication during a human/animal health crisis, adopting the ‘One Health’ approach. Italy, Spain, Portugal, France, Greece, Albania, Croatia, Montenegro and Turkey were the beneficiary countries, while European Commission (EC), European Centre for Disease Prevention and Control (ECDC), World Health Organisation (WHO), World Organisation for Animal Health (WOAH) and Food and Agricultural Organisation (FAO) were the designated observers who were actively involved along the entire capacity building process. The simulation exercise was based on a fictional case study in which the zoonotic mosquito-borne disease, not currently present in Europe, was accidentally introduced into the European Union via the accidental transfer of infected vectors from a RVF-endemic country. The training activity was positively assessed by the participants and useful suggestions were given to address further future similar initiatives.

Information Security Risk Assessment Using Situational Awareness Frameworks and Application Tools

This paper describes the development of situational awareness models and applications to assess cybersecurity risks based on Annex ISO 27001:2013. The risk assessment method used is the direct testing method, namely audit, exercise and penetration testing. The risk assessment of this study is classified into three levels, namely high, medium and low. A high-risk value is an unacceptable risk value. Meanwhile, low and medium risk values can be categorized as acceptable risk values. The results of a network security case study with security performance index indicators based on the percentage of compliance with ISO 27001:2013 annex controls and the value of the risk level of the findings of the three test methods showed that testing with the audit method was 38.29% with a moderate and high-risk level. While the test results with the tabletop exercise method are 75% with low and moderate risk levels. On the other hand, the results with the penetration test method are 16.66%, with moderate and high-risk levels. Test results with unacceptable risk values or high-risk corrective actions are taken through an application. Finally, corrective actions have been verified to prove there is an increase in cyber resilience and security.

An exercise in disaster: Does policy learning occur after a tabletop crisis scenario?

AbstractIt is well‐established that experience with a disaster can heighten risk perception, initiate policy learning, and ultimately enhance preparedness and mitigation. This experience can make stakeholders more amenable to mitigating risk, but disasters are sporadic, dangerous, and costly. At the same time, the importance of differences in epistemic communities that manage public agencies and departments has received little attention in the context of policy learning, preparedness, and mitigation. This study investigates whether it is possible for simulated disasters, such as tabletop exercises, to influence risk perception and encourage learning in a way that is consistent with the effects of experiencing an actual disaster. To test this idea, we analyze survey data collected from an Environmental Protection Agency workshop of drinking water officials and public health stakeholders from southeast Michigan and northwest Ohio, including Detroit, Flint, and Toledo. A pre and posttest survey captured participants' beliefs before and after a tabletop exercise designed to simulate a large‐scale drinking water disaster. Results suggest that epistemic communities matter in these exercises but professional experience is less important than what previous studies have shown about experience with a policy problem and policy learning.

Preliminary Evaluation of the Bioness Integrated Therapy System Touch Screen Technology in Improving Visual Field Awareness Related to Neurological Injury in the Inpatient Setting

Abstract Date Presented 04/02/2022 After a stroke, patients may have some degree of visual field deficit. There is a current lack of consensus on the best practices for improving these deficits. The goal of this study is to determine whether Bioness Integrated Therapy System touch screen technology more effectively improves visual field deficits than conventional table-top exercises. Preliminary Bell’s Test data for 10 participants are presented. These data suggest that patients may benefit more from an interactive technology-based regimen than conventional exercises. Primary Author and Speaker: Heidi Fagan Additional Authors and Speakers: Jaclyn Lavigne Contributing Authors: John J. Pulaski, Henry C. Hrdlicka, Emily Meise, Megan Palmer, Amanda Meyer

A Framework for Dynamic Composition and Management of Emergency Response Processes.

An emergency response process outlines the workflow of different activities that need to be performed in response to an emergency. Effective emergency response requires communication and coordination with the operational systems belonging to different collaborating organizations. Therefore, it is necessary to establish information sharing and system-level interoperability among the diverse operational systems. Unlike typical e-government processes that are well structured and have a well-defined outcome, emergency response processes are knowledge-centric and their workflow structure and execution may evolve as the incident unfolds. It is impractical to define static plans and response process workflows for every possible situation. Instead, a dynamic response should be adaptable to the changing situation. We present an integrated approach that facilitates the dynamic composition of an executable response process. The proposed approach employs ontology-based reasoning to determine the default actions and resource requirements for the given incident and to identify relevant response organizations based on their jurisdictional and mutual aid agreement rules. The Web service APIs of the identified response organizations are then used to generate an executable response process that evolves dynamically. The proposed approach is implemented and experimentally validated using an example scenario derived from the FEMA Hazardous Materials Tabletop Exercises Manual.