Using Tabletop Exercises Carl Osaki, MSPH, RS Clinical Associate Professor Emeritus Dept of Environmental & Occupational Health Sciences, School of Public Heatlh, Univ of WA Everything You Need to Know... and More

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

Your Experiences I Have you participated in a tabletop exercise? Yes No What was the most significant problem you experienced as a participant in the process?

Your Experiences II Have you facilitated a tabletop exercise? Yes No What was your most significant challenge in facilitating the tabletop?

Your Experiences III Have you designed a tabletop exercise? Yes No What resources/tools did you use to help design the tabletop?

What is a Tabletop? Hypothetical scenario (story) depicting a large- scale public health emergency A facilitator leads the group (players) in a discussion about a series of incidents (problems) which emerge in the scenario Players identify and discuss the policies and procedures needed to address each incident Hotwash to discuss the significance of the policies to their own organization (e.g., gaps, duplications, confusion, and whether people are trained to carry out the policies) Debriefing to discuss exercise, next steps Low stress, no right or wrong answer

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 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

When Should a Tabletop Be Used? Discussion-based Exercises –Orientation –Tabletop Operations-based Exercises –Drill –Functional –Full-Scale

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

How Do I Design My Own Tabletop? NW Center BT Tabletop Office of Homeland Security NACCHO BT Create CDC ( ) Time to design: (20 to 40 hours) Roles (player, facilitator, observer, recorder, evaluator, resources)

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)

Successful Tabletops: 10 Things to Consider Facilitator Audience Burn-out Materials Reality Jargon Recorder Debriefing Group size Group composition

How do I determine the success of a tabletop? Evaluation through debriefing –The exercise (meets objectives) –The hotwash (Identification of needed policies, gaps & duplications, policies being effectively practiced) After-Action Report Development of work plan