Using Tabletop Exercises Everything You Need to Know ... and More Carl Osaki, MSPH, RS Northwest Center for Public Health Practice, Clinical Associate Professor Department of Environmental & Occupational Health Sciences, SPHCM, University of Washington

Objectives Describe the value and use of tabletop exercises to prepare for public health emergencies List 10 suggestions for conducting or facilitating a successful tabletop exercise Discuss how to evaluate your agency’s readiness for conducting a tabletop exercise

Overview Define a tabletop exercise Describe the purpose and objectives of tabletops Discuss who uses tabletops and why Describe issues typically raised through tabletops Discuss how to consider appropriate tabletops and where to find them Suggest issues to consider in designing or conducting your own tabletop

Poll: Your Experiences I Have you participated in a tabletop exercise? Yes No Enter your answer in the feedback poll (on left side of screen) If yes, tell us over the phone: What was the most significant problem you experienced as a participant in the process?

Your Experiences II Yes No Have you facilitated a tabletop exercise? If yes, type your answer into the text chat window: What was your most significant challenge in facilitating the tabletop?

What is a Tabletop? Hypothetical scenario (story) depicting a large-scale public health emergency A facilitator leads the group (players) in identifying responses to a series of incidents in the scenario Low stress, no right or wrong answer Examines the adequacy of the plans, policies and procedures in place (e.g., gaps, duplications, confusion, and the key decision makers’ understanding of the plans) Debriefing to discuss next steps

Types of Tabletops Basic: players respond to scenario as it unfolds, can be a mix of different disciplines, not necessarily key decision makers. More oriented to learning, rather than evaluation of current system Advanced: players in own role as defined by the emergency response plan; typically those that would be involved in decision making; identifies gaps, inconsistencies, or duplications in policies, plans, or procedures

Who Uses Tabletops in Public Health? PH Agencies (local, state, tribal) Schools/PH Institutes (summer institutes, classroom) Local emergency response agencies PH Agencies - interested in identifying agency’s systems gaps, identifying training needs; learning about designing & facilitating tabletops; relatively inexpensive to conduct (as compared with full scale drills/exercises) Schools/PH Institutes – learning about a teaching tool, prepare future or existing workforce about components of emergency preparedness; identify training needs; illustrating the policy issues associated with emergency response Local emergency response agencies – identify gaps and duplications in local preparedness; evaluate PH emergency response structure; clarify roles of emergency responders, develop teamwork; Identify training needs Specific disciplines – clarify role of discipline in preparedness Professional disciplines (MDs, nurses, veterinarians, environmental health specialists, epidemiologists, etc)

What are Typical Tabletop Objectives? Identify the policy issues associated with a public heath emergency Identify gaps in local preparedness Discuss measures that can be performed at the local level Promote interagency collaboration & coordination Recognize the roles of public officials Identify training needs Demonstrate a teaching tool Evaluate self-reported assessment

Putting Tabletops in Context Discussion-based exercises Orientation Tabletop Operation-based exercises Drill Functional Full-Scale Orientation – new staff or changes to existing procedures – 1 to 2 hours Drill – testing response to learning through repetitive activities (cmu, response time, accuracy) – 1 – 3 hours Tabletop Exercises – learning experience, identify systems gaps – 2 -4 hours Functional - test and evaluate the capabilities of the emergency response system, scenario with messages to players, actual members of ICS – 4 – 8 hrs) Full Scale - tests and evaluates a major portion of the emergency operations plan in the field; simulated victims played out over an extended period of time. (1 to 2 days)

Where Do I Find Tabletops? NWCPHP PH Preparedness Training Centers Private firms ASPH NACCHO

Your Experiences III Yes No Have you designed a tabletop exercise? If yes, tell us over the phone: What resources/tools did you use to help design the tabletop?

How Do I Design My Own Tabletop? NW Center BT Tabletop with instructions Homeland Security Web site NACCHO BT Create Time to design: (20 to 40 hours)

What issues are raised through tabletops? Communication (vertical, horizontal, news media) Resources (manpower, material, technical assistance) Data (collection, analysis, mgmt, communicating) Coordination (chain of command, leadership) Legal (medical, criminal, quarantine, confidentiality) Systems (interagency protocols, surveillance, ICS) Mental health (public fears, responders – stress)

Top 10 Things to Consider: Successful Tabletops Top 10 Things to Consider: Facilitator Audience Burn-out Materials Reality Jargon Recorder Debriefing Group size Group composition FACILITATOR. Use an experienced and skillful facilitator - clarify, probe, advance the scenario THE AUDIENCE. Understand the audience’s training needs – pre interview BURN OUT. The saturation point is about 2 hours for the exercise MATERIALS. Create good handouts and distribute strategically; good power points (with illustrations, maps, etc if possible) REALITY. Design a creditable, but challenging scenario ( pick something people can relate to; remember it’s not about people’s knowledge about a disease, but about the systems’ ability to address it) JARGON. Use words all can understand. (PH jargon will confuse non-PH players) RECORDER. Assign a non-playing recorder to take notes for debriefing and evaluation/next steps DEBRIEFING. Make the debriefing as important as the exercise itself GROUP SIZE. Keep the group size manageable (15 to 20 players), have the right people at the table GROUP COMPOSITION. Try to have decision makers or second in command at the table for advanced tabletops

How do I determine the success of a tabletop? Evaluation through debriefing The exercise (objectives met) The preparedness plan (policies identified, in place, and practiced) After-Action Report Development of work plan

Q & A Questions? Comments?