Jul 03, 2025

Public workspaceTabletop Exercises for Prehospital Preparedness During Emergencies: A Scoping review protocol.

DOI
https://dx.doi.org/10.17504/protocols.io.e6nvw4p7wlmk/v1
  • Maitha Kazim1,
  • Paurnami Prashanth1,
  • Dayol narayanan2,
  • Salma Abdalla Elmisbah1,
  • Nabil Zary3,
  • Ives Hubloue4,5,
  • Abu Omayer6,
  • Azza Yousif1,
  • Azza Yousif7,
  • Ali AlRahma8
  • 1Rashid Hospital, Dubai Health, Dubai, UAE;
  • 2Dubai corporation for Ambulance services, Dubai, UAE;
  • 3Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, UAE;
  • 4Emergency Department, UZ Brussel University Hospital, Belgium;
  • 5Disaster Medicine Research Group, Vrije Universiteit Brussel. Belgium;
  • 6Mohammed Bin Rashid University of Medicine and Health Sciences;
  • 7DUBAI HEALTH;
  • 8Rashid Hospital - Dubai Health
Nabil Zary
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DOI: https://dx.doi.org/10.17504/protocols.io.e6nvw4p7wlmk/v1
Protocol Citation: Maitha Kazim, Paurnami Prashanth, Dayol narayanan, Salma Abdalla Elmisbah, Nabil Zary, Ives Hubloue, Abu Omayer, Azza Yousif, Azza Yousif, Ali AlRahma 2025. Tabletop Exercises for Prehospital Preparedness During Emergencies: A Scoping review protocol.. protocols.io https://dx.doi.org/10.17504/protocols.io.e6nvw4p7wlmk/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License,  which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: July 03, 2025
Last Modified: July 03, 2025
Protocol Integer ID: 221638
Keywords: tabletop exercises, prehospital care, emergency preparedness, EMS training, mass casualty incident, disaster simulation, Kirkpatrick Model, scoping review, other prehospital emergency training context, prehospital emergency preparedness, tabletop exercises for prehospital preparedness, prehospital preparedness, impact on preparedness activity, preparedness activity, use in medical emergency, emergency scenario, prehospital setting, communication in emergency scenario, medical emergency, emergency, training evaluation, hospital admission, training context, scoping review protocol introduction, scoping review protocol, disaster type, use of tte, outcome, scr guideline, disaster, role of tte, em, evaluation, guideline, training
Abstract
Introduction:
Tabletop exercises (TTEs) are low-stress, discussion-based simulations designed to enhance decision-making, coordination, and communication in emergency scenarios. While recent articles have explored their use in medical emergencies, the role of TTEs in prehospital settings, specifically their impact on preparedness activities leading up to hospital admission remains underexplored.

Purpose: This scoping review systematically maps existing evidence on how TTEs are used to assess and improve prehospital emergency preparedness.

Methods: Conduct the scoping review following the Arksey and O’Malley framework with Levac refinements and PRISMA-ScR guidelines. Include studies published in English within the past 10 years that involve the use of TTEs in EMS or other prehospital emergency training contexts. Search multiple medical, educational, and grey literature databases comprehensively. Extract and synthesize data related to TTE structure, training context, target populations, disaster types, and outcome measures. Map reported outcomes to the Kirkpatrick Model of training evaluation. Incorporate stakeholder consultation throughout the review process.


Guidelines
Guidelines
1. PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist. 2. Arksey and O'Malley Scoping Review Framework. 3. PRESS (Peer Review of Electronic Search Strategies) guidelines.
Materials
Computers, Internet Connection, MS Word, MS Excel, Reference Manager (Mendeley/EndNote/Zotero), Covidence.
Troubleshooting
Objectives:
Map and analyze how tabletop exercises (TTEs) are employed to assess and enhance prehospital preparedness during mass casualty incidents (MCIs) and other emergency scenarios.
Explore the contexts in which TTEs are used, such as disaster versus non-disaster scenarios, interprofessional education (IPE) versus non-IPE formats, and the presence or absence of game-based elements.
Classify, where available, reported outcomes and educational impacts.
Inform healthcare educators, emergency planners, and institutional decision-makers with the findings of this review.
Provide a foundational framework for future researchers to design and build primary studies.
Methodology Overview
Follow the methodological framework established by Arksey and O'Malley, incorporating enhancements recommended by Levac et al.
Adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines.
Develop and register the protocol on protocols.io.
Submit the protocol to appropriate international registries for systematic review protocols.
Stage 1: Identify the research question
Primary Research Question:
In what ways have tabletop exercises (TTEs) been used to assess or enhance prehospital preparedness during emergencies?
Secondary Research Questions:
Have these TTEs been implemented in the context of disaster response, routine emergency preparedness, or non-disaster scenarios?
Were they conducted as interprofessional education (IPE) exercises or within a single-discipline framework?
Did any of the exercises incorporate game-based or board-game elements?
What outcomes have been reported from studies using TTEs in prehospital emergency preparedness, based on the Kirkpatrick Model of training evaluation?
Which levels of the model (Reaction, Learning, Behavior, Results) are most frequently addressed?
Are certain outcome levels underrepresented in the current literature?
What are the key characteristics of studies using TTEs in prehospital settings?
Stage 2: Identify relevant studies
Databases: PubMed, Embase, Scopus, PsycINFO, CINAHL, Cochrane Library, ClinicalTrials.gov, and Google Scholar.
Create the search strategy using a combination of keywords and Medical Subject Headings (MeSH), identified through the MeSH database on PubMed.
Keywords

Submit the search strategy for peer review following the PRESS (Peer Review of Electronic Search Strategies) guidelines to enhance accuracy and completeness.
Adapt the search strategy for each database: PubMed, Embase, Scopus, PsycInfo, CINAHL, Cochrane Library, and ClinicalTrials.gov.


Search Strategies
Manually search Google Scholar to capture relevant studies missed in database searches and to identify grey literature.
Stage 3: Study selection
Include studies involving first responders, EMS personnel, paramedics, ambulance teams, disaster response teams, and healthcare trainees (students, interns, residents, physicians) who participate in prehospital tabletop exercises.
Select studies conducted in academic, clinical, field-based, or professional training environments focused on prehospital emergency preparedness.
Include interventions that use tabletop exercises (TTEs), either as stand-alone activities or as part of a multicomponent intervention (e.g., simulation, lectures, or workshops).
Include studies that report on TTEs addressing prehospital planning, triage, response coordination, or decision-making in simulated emergencies or disaster scenarios, and that report at least one learning outcome aligned with the Kirkpatrick Model.
Include studies published in English within the last 10 years.
Consider a range of study designs, including qualitative, quantitative, mixed-methods studies, case reports, commentaries, pedagogical descriptions, conference proceedings, and viewpoint articles.
Exclude studies that focus solely on in-hospital preparedness or omit the prehospital phase of emergency response.
Exclude reviews, including systematic reviews, literature reviews, and other scoping reviews.
Stage 4: Data Charting
Develop the data extraction form by piloting five eligible studies. Identify common variables relevant to tabletop exercises in prehospital preparedness during emergencies.
Study Identification and Context
  • Study ID
  • Country
  • Study Design
  • Disaster Type
  • Prehospital Focus
Participant and Setting Characteristics
  • Population Type
  • Sample Size
  • Training Setting
  • Interprofessional Involvement
Intervention Description
  • TTE Description
  • Exercise Objectives
  • Number of Scenarios
  • Duration of Exercise
  • Pre-Exercise Lecture
  • Supplementary Resources
  • Real-World Alignment
Evaluation and Assessment
  • Pre-TTE Evaluation
  • Post-TTE Evaluation
  • Comparator
  • Measurement Tools
  • Competency Tracking
  • Self-Reported Measures
  • Outcomes Assessed
  • Kirkpatrick Level
Implementation Factors
  • Subject Matter Experts Availability
  • Support Team Availability
  • Debriefing
Findings and Interpretation
  • Main Findings
  • Gaps Identified
  • Barriers and Challenges
  • Limitations Reported
  • Key Message
Stage 5: Collating, Summarising, and Reporting the Results
Two independent reviewers verify key study details to ensure accuracy and consistency.
Resolve any disagreements through discussion or consultation with a third reviewer.
Use Microsoft Excel to compile and structure all extracted data for analysis.
Summarize and display the findings using tables, figures, and visual illustrations.
Analyze quantitative data descriptively (e.g., frequencies, sample sizes).
Conduct thematic analysis of qualitative data
Thematically analyse studies based on the following domains:
  • Study focus and objectives
  • Educational or training context
  • Target populations (e.g., EMS personnel, paramedics, first responders)
  • TTE characteristics (e.g., format, setting, disaster type)
  • Outcomes reported, categorized using the Kirkpatrick Model
Identify Gaps and Make Recommendations
Stage 6: Conduct Stakeholder Consultation (Optional Stage)
Engage relevant stakeholders involved in the design, delivery, or evaluation of tabletop exercises (TTEs) for prehospital emergency preparedness as part of an optional consultation step.
Include participants such as EMS educators, emergency physicians, paramedics, disaster management officials, policymakers, and simulation specialists.
Dissemination
Submit the final manuscript to a peer-reviewed journal specializing in emergency medicine, disaster preparedness, or simulation-based training.
Present key results at leading national and international conferences
Timeline:
Month 1: Registration & stakeholder meeting
Months 2-3: Search execution & import
Months 4-5: Screening
Months 6-7: Data extraction
Month 8: Synthesis workshop
Month 9: Draft manuscript
Month 10: Peer review & protocols.io publication
Protocol references
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1):19-32.
Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implementation Sci. 2010 Dec;5(1):69.
Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473.
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. Journal of Clinical Epidemiology. 2016 Jul;75:40–6.