*Article*

## **Alternative Leadership in Flexible Surge Capacity—The Perceived Impact of Tabletop Simulation Exercises on Thai Emergency Physicians Capability to Manage a Major Incident**

#### **Phatthranit Phattharapornjaroen 1,2, Viktor Glantz 1, Eric Carlström 3,4, Lina Dahlén Holmqvist 5 and Amir Khorram-Manesh 1,6,\***


Received: 16 July 2020; Accepted: 1 August 2020; Published: 2 August 2020

**Abstract:** Flexible surge capacity aims to activate and utilize other resources than normally are surged in a community during the primary and secondary surge capacity. The presence of alternative leadership, skilled and knowledgeable in hospital and prehospital emergency management, is invaluable. Thai emergency physicians work at both levels, emphasizing their important role in emergency managemen<sup>t</sup> of any source in a disaster-prone country. We aimed to investigate Thai emergency physicians' ability in terms of knowledge and preparedness to manage potential emergencies using tabletop simulation exercises. Using an established method for training collaboration, two training courses were arranged for over 50 Thai emergency physicians, who were divided into three teams of prehospital, hospital, and incident command groups. Three scenarios of a terror attack along with a bomb explosion, riot, and shooting, and high building fire were presented, and the participants' performance was evaluated regarding their preparedness, response and gained knowledge. Two senior observers followed the leadership characteristic in particular. Thai physicians' perceived ability in command and control, communication, collaboration, coordination, and situation assessment improved in all groups systematically. New perspectives and innovative measures were presented by participants, which improved the overall managemen<sup>t</sup> on the final day. Tabletop simulation exercise increased the perceived ability, knowledge, and attitude of Thai emergency physicians in managing major incidents and disasters. It also enabled them to lead emergency managemen<sup>t</sup> in a situation when alternative leadership is a necessity as part of the concept of a flexible surge capacity response system.

**Keywords:** disasters; emergencies; flexible surge capacity; leadership; Thailand; 3LC
