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

2. Presentation 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.

3. Learning Objectives  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. By the end of this presentation, learners will be able to :

4. Your Experiences (1 of 3) Have you participated in a tabletop exercise? Yes No What was the most significant problem you experienced as a participant in the process?

5. Have you facilitated a tabletop exercise? Yes No What was your most significant challenge in facilitating the tabletop? Your Experiences (1 of 2)

6. Your Experiences (3 of 3) Have you designed a tabletop exercise? Yes No What resources/tools did you use to help design the tabletop?

7. What Is a Tabletop?  A tabletop is a 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.  Players debrief to discuss the significance of the policies to players’ own organization (e.g., gaps, duplications, confusion, and whether people are trained to carry out the policies).  Tabletops are low stress—there are no right or wrong answers.

8. Types of Tabletops  Basic  Players respond to scenario as it unfolds. Players can be from a mix of different disciplines, not necessarily key decision makers. More oriented to learning, rather than evaluation of current system.  Advanced  Players act in own roles as defined by the emergency response plan, and are typically those that would be involved in decision making. Exercise identifies gaps, inconsistencies, or duplications in policies, plans, or procedures.

9. 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)

10. 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 and coordination.  Recognize the roles of public officials.  Identify training needs.  Demonstrate a teaching tool.  Evaluate self-reported assessment.

11. When Should a Tabletop Be Used?  Discussion-based exercises  Orientation  Tabletop  Operations-based exercises  Drill  Functional  Full-Scale

12. Where Do I Find Tabletops?  NWCPHP  http://www.nwcphp.org  PH Preparedness Training Centers  Private firms  ASPH  http://www.asph.org  NACCHO  http://www.naccho.org

13. How Do I Design My Own Tabletop?  NWCPHP BT Tabletop  Office of Homeland Security  http://www.ojp.usdoj.gov/odp/exercises.htm  NACCHO BT Create  CDC  http://www.bt.cdc.gov  Time to design: 20 to 40 hours  Roles: player, facilitator, observer, recorder, evaluator, resources

14. What Issues Are Raised Through Tabletops?  Communication (vertical, horizontal, news media)  Resources (personnel, material, technical assistance)  Data (collection, analysis, management, communicating)  Coordination (chain of command, leadership)  Legal (medical, criminal, quarantine, confidentiality)  Systems (interagency protocols, surveillance, ICS)  Mental health (public fears, responders’ stress)

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

16. How Do I Determine Success of a Tabletop?  Evaluation through debriefing  The exercise (meets objectives)  The plan (identification of needed policies, gaps and duplications, policies being effectively practiced)  After-action report  Development of work plan