Search Results (16)

In early 2024, the largest full-scale exercise (FSE) for earthquakes and related geohazards in Greece was implemented in Crete Island (southern Greece). Crete is characterized by intense seismicity with historical and recent destructive earthquakes with considerable impact on both the natural and built environment and subsequently on the population. The uniqueness of this FSE lies in the creation and coordination of a multi-agency, multijurisdictional, and multidisciplinary environment in which a multitude of central, regional, and local stakeholders and a large percentage of the total population of Crete actively participated. This paper constitutes a descriptive study focusing on the main steps of the exercise management cycle comprising planning, implementation, and evaluation of the FSE. Furthermore, emphasis is given on its purpose and objectives, its main events and subsequent incidents, the participants and their roles, as well as the material developed and distributed to the participants. Through this study, the implemented actions for increasing preparedness of the Civil Protection mechanism in case of earthquakes and related geohazards are highlighted aiming to inform the scientific community and operational staff and to contribute to the seismic risk reduction of regions worldwide with similar seismotectonic and demographic characteristics with Crete. Furthermore, suggestions are made for the integration of multi-hazard episodes in the FSE scenario in order that the Civil Protection authorities will be prepared to handle the synergy of hazards of different types that may arise during a post-earthquake period that create compounding challenges during the emergency response and further increase recovery time. Full article

Tabletop exercises offer a structured opportunity to assess strengths and potential gaps in preparedness and response plans in a safe learning environment. The New York City Health + Hospitals System-Wide Special Pathogens Program conducted an innovative and multidisciplinary tabletop exercise involving escalating scenarios of highly pathogenic avian influenza (HPAI) H5N1 in 2023. The goals were to assess patient screening processes for infectious diseases within healthcare facilities, infection prevention and control strategies, risk communication, and notification and involvement of public health stakeholders. Participants reflected on previous outbreak responses, discussed the importance of risk communication, and shared insights on tools and resources that would better support healthcare professionals in identifying and managing patients with HPAI/H5N1 infection. Key takeaways included establishing clear protocols for HPAI/H5N1 management, providing timely education to healthcare professionals, and assessing useful communication modalities. Methods: The exercise included escalating scenarios involving a single case of HPAI/H5N1 advancing to community transmission. Key participants spanned clinical departments, infection prevention and control, emergency management, and local public health stakeholders. Structured discussions targeted triggers for escalation, infection prevention strategies, and communication pathways. Results: Findings highlighted the need for tailored screening criteria, robust infection prevention protocols, clear communication strategies, and collaboration with public health authorities. Specific improvements included refining triage and isolation protocols, enhancing staff education, and leveraging syndromic surveillance systems. Conclusion: This exercise underscored the importance of proactive planning, multidisciplinary collaboration, and integration of biosafety measures to strengthen healthcare system resilience against HPAI/H5N1. Full article

Despite noble intentions, new technologies may have adverse effects on the resilience of the sociotechnical systems into which they are integrated. Our objective was to develop a lightweight method to elicit requirements that, if implemented, would support sociotechnical system resilience. We developed and piloted the Resilience-Aware Development Exercise Protocol (RAD-XP), a method to generate tabletop exercises (TTXs) to elicit resilience requirements. In the pilot study, this approach generated 15 requirements from a one-hour TTX, where the majority of requirements were found to support resilience. Participants indicated via survey that RAD-XP was effective and efficient, and that they would want to use RAD-XP regularly throughout the agile development process. We discuss future research and development to refine this approach to eliciting resilience requirements. Full article

This study developed and evaluated a tabletop program for training nurses working in small- to medium-sized hospitals in areas with poor healthcare access for emerging a tabletop program for training emerging infectious disease responses in nurses working at small- to medium-sized hospitals in areas with poor healthcare access and evaluated infectious disease responses. A tabletop program for training responses to emerging infectious diseases was provided to 29 nurses at a general hospital with <300 beds in a region without a tertiary general hospital or healthcare institution with nationally designated inpatient wards for patients with infectious diseases. The 180 min program consisted of an online theoretical lecture (Phase 1), one-on-one drills (Phase 2), and a scenario-based tabletop exercise (Phase 3). To evaluate the program’s effect, pre- and post-knowledge, awareness, and competencies related to responses to emerging infectious diseases were assessed. The mean knowledge score significantly improved from 11.41 ± 2.33 before the training to 16.69 ± 2.48 after the training (z = −4.529, p < 0.001). The mean awareness score significantly improved from 80.83 ± 11.94 before the training to 85.45 ± 7.08 after the training (z = −2.335, p = 0.020). The mean competence score significantly increased from 67.31 ± 14.75 before the training to 79.38 ± 10.39 after the training (t = −6.187, p < 0.001). The tabletop exercise program effectively enhanced the nurses’ competencies in responding to emerging infectious diseases. The training program developed in this study may be utilized in addition to a simplified theoretical lecture to train nurses to improve their competency in responding to emerging infectious diseases. Full article

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. Full article

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. Full article

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. Full article

Cyberdisasters require an organization’s disaster team to be prepared. Disaster events are difficult to predict, but the impact of this risk on an organization is large. However, organizations sometimes struggle in being prepared for disaster situations. Here, awareness of disaster situations when analysing priority disasters (e.g., earthquakes and pandemics) and how to mitigate them can help an organization’s preparedness. Mitigation scenarios need to be determined and simulated so that a disaster team is ready to face disaster. Using Endsley’s situational awareness model and a tabletop exercise, this study aimed to help a disaster team determine cyberdisaster risk priority and assess a team’s preparedness for dealing with a cyberdisaster. The situation awareness model was divided into two stages: awareness of cyberdisaster situations and tabletop evaluations. Awareness of a disaster situation was carried out by determining the highest priority for disaster risk using the fuzzy failure modes and effects analysis (FMEA) method. The results of the first study show that the high-risk category contains ransomware attacks during pandemics and earthquakes. The second study performed a tabletop simulation questionnaire survey of earthquakes and ransomware attacks during a pandemic for several disaster teams with 152 respondents. The results of the survey evaluation of the earthquakes and ransomware attacks simulation survey show that the effect factors of cyberdisaster simulation decisions are 95% system capability (p < 0.05), 90% knowledge (p < 0.05), and 90% awareness of a disaster situation (p < 0.05); these factors show the effect of a disaster team’s decision during a tabletop simulation. The novelty of this research lies in building a model for how an organizational process determines the priority of a cyberdisaster tabletop simulation and the factors that contribute to increasing a disaster team’s awareness in dealing with cyberattacks. Full article

The nominal group technique (NGT) was developed in the 1970s as a structured brainstorming and multi-stage consensus-building process to solicit feedback from a group of stakeholders on a given topic. The approach was intended as an evaluation method to provide semi-quantitative rank-ordered feedback from group participants. This lecture presents a variation of this technique created by the Harvard team, namely “scenario-based NGT”. The format proposed includes elements of tabletop exercises (scenario with a timeline and discussion phase) as well as elements of traditional NGTs (silent brainstorming and ranking). The technique we developed was based on a case-study approach (“scenario”) which we then tested in two countries (USA and Sweden) with existing P/CVE initiatives at different stages of development. We conducted scenario-based NGT sessions in both locations and then systematically analyzed the results using iterative qualitative coding based on a common framework. Results were analyzed to achieve consensus on the most common system-level challenges and system-level functions, necessary to overcome those challenges, in each location. Full article

This study used a descriptive cross-sectional methodology to measure healthcare workers’ knowledge, attitudes, perceptions, and willingness to respond to a flood scenario in Saudi Arabia. A validated survey was distributed to collect data using a convenience sampling technique through multiple social media platforms. A total of 227 participants were included in this study: 52% of them were aged between 26 to 34 years, 74% were residents from Riyadh, and 52.4% worked in nursing divisions. A significant number of respondents (73.2%) had positive perceptions towards their hospitals’ ability to provide an effective response to a flood, 89% were willing to report to work following a flood, and 90% of participants reported the need to develop both guidelines and training for flood disaster preparedness. Preparation and successful flood mitigation in the hospital setting requires staff that have both knowledge and training in emergency management. One way to obtain such readiness is through competency-based training, including both table-top and full-scale live exercises. Although the willingness to respond to such a flooding emergency was high among staff, the development of guidelines and educational programs is needed in order to develop the competencies and skills sets to improve disaster preparedness response and preparedness efforts. Full article

Compound flooding, resulting from a combination of riverine and coastal processes, is a complex but important hazard to resolve along urbanized shorelines in the vicinity of river mouths. However, inland flooding models rarely consider oceanographic conditions, and vice versa for coastal flood models. Here, we describe the development of an operational, integrated coastal-watershed flooding model to address this issue of compound flooding in a highly urbanized estuarine environment, San Francisco Bay (CA, USA), where the surrounding communities are susceptible to flooding along the bay shoreline and inland rivers and creeks that drain to the bay. The integrated tributary-coastal forecast model (Hydro-Coastal Storm Modeling System, or Hydro-CoSMoS) was developed to provide water managers and other users with flood forecast information beyond what is currently available. Results presented here are focused on the interaction of the Napa River watershed and the San Pablo Bay at the northern end of San Francisco Bay. This paper describes the modeling setup, the scenario used in a tabletop exercise (TTE), and the assessment of the various flood forecast information products. Hydro-CoSMoS successfully demonstrated the capability to provide watershed and coastal flood information at scales and locations where no such information is currently available and was also successful in showing how tributary flows could be used to inform the coastal storm model during a flooding scenario. The TTE provided valuable feedback on how to guide continued model development and to inform what model outputs and formats are most useful to end-users. Full article

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 management 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 management 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 management in a situation when alternative leadership is a necessity as part of the concept of a flexible surge capacity response system. Full article

Background: Prior to the 2009 pandemic H1N1, and the unprecedented outbreak of Highly Pathogenic Avian Influenza (HPAI) caused by the H5N1 virus, the World Health Organization (WHO) called upon its Member States to develop preparedness plans in response to a new pandemic in humans. The WHO Member States responded to this call by developing national pandemic plans in accordance with the International Health Regulations (IHR) to strengthen the capabilities of Member States to respond to different pandemic scenarios. In this study, we aim to evaluate the quality of the preparedness plans in the WHO African region since their inception in 2005. Methods: A standard checklist with 61 binary indicators (“yes” or “no”) was used to assess the quality of the preparedness plans. The checklist was categorised across seven thematic areas of preparedness: preparation (16 indicators); coordination and partnership (5 indicators); risk communication (8 indicators); surveillance and monitoring (7 indicators); prevention and containment (10 indicators); case investigation and treatment (10 indicators) and ethical consideration (5 indicators). Four assessors independently scored the plans against the checklist. Results: Of the 47 countries in the WHO African region, a total of 35 national pandemic plans were evaluated. The composite score for the completeness of the pandemic plans across the 35 countries was 36%. Country-specific scores on each of the thematic indicators for pandemic plan completeness varied, ranging from 5% in Côte d'Ivoire to 79% in South Africa. On average, preparation and risk communication scored 48%, respectively, while coordination and partnership scored the highest with an aggregate score of 49%. Surveillance and monitoring scored 34%, while prevention and containment scored 35%. Case investigation and treatment scored 25%, and ethical consideration scored the lowest of 14% across 35 countries. Overall, our assessment shows that pandemic preparedness plans across the WHO African region are inadequate. Conclusions: Moving forward, these plans must address the gaps identified in this study and demonstrate clarity in their goals that are achievable through drills, simulations and tabletop exercises. Full article

We applied a real-time tsunami inundation forecast system to a disaster response plan. We developed a standard operating procedure (SOP) for a tsunami disaster response based on a Plan, Do, Check, Action cycle to effectively use tsunami observation and prediction information provided by a real-time tsunami inundation forecast system during an initial response to a tsunami disaster. In the Plan stage, we ran a workshop on the tsunami disaster response to confirm the current tsunami disaster response plan and develop a timeline plan for a tsunami disaster. In the Do stage, we conducted a tabletop exercise (TTX) for a tsunami disaster using a real-time tsunami prediction system. In the Check stage, we ran a workshop on an after-action review of the TTX. In the Action stage, we applied the SOPs of the real-time tsunami prediction system to the tsunami disaster management plan and conducted a second TTX. As a result, we verified the information provided by a real-time tsunami prediction system to apply the system to a tsunami disaster management plan for real municipalities. It was confirmed that the SOP that we developed allows a real-time tsunami inundation forecast system to enable government staff to safely and effectively respond during a disaster. Full article

A tabletop system can facilitate multi-user collaboration in a variety of settings, including small meetings, group work, and education and training exercises. The ability to identify the users touching the table and their positions can promote collaborative work among participants, so methods have been studied that involve attaching sensors to the table, chairs, or to the users themselves. An effective method of recognizing user actions without placing a burden on the user would be some type of visual process, so the development of a method that processes multi-touch gestures by visual means is desired. This paper describes the development of a multi-touch tabletop system using infrared image recognition for user position identification and presents the results of touch-gesture recognition experiments and a system-usability evaluation. Using an inexpensive FTIR touch panel and infrared light, this system picks up the touch areas and the shadow area of the user’s hand by an infrared camera to establish an association between the hand and table touch points and estimate the position of the user touching the table. The multi-touch gestures prepared for this system include an operation to change the direction of an object to face the user and a copy operation in which two users generate duplicates of an object. The system-usability evaluation revealed that prior learning was easy and that system operations could be easily performed. Full article