Building Resilience Together: An International Collaboration in Designing a Multi-Agency Disaster Tabletop Drill – Insights, Challenges, and Lessons Learned

Summary: Disaster response often requires complex, multi-agency efforts and brings together responders and leaders from various backgrounds. International response can be complicated by varying clinical practices, lack of coordination, and differing cultures and languages. Tabletop exercises are well-established techniques to improve readiness and coordination in disaster response. In April 2024, an international group of disaster medicine experts from the United States, Canada, and France designed, planned, and facilitated a multi-agency tabletop exercise for the disaster response elements based in Toulouse, France. A structured post-exercise debrief with this team was performed, and distinct themes were extrapolated, including successes, challenges, and lessons learned in designing, planning, and facilitating this tabletop. Successes in designing and planning the exercise included multidisciplinary collaboration, early coordination with the core planning team, detailed scenario design, the experience of planners, well-timed injects, and good stakeholder participation. Challenges include understanding the capabilities of responding agencies, language barriers, last-minute changes and participation, changing objectives, time zone coordination, and lack of follow up. Successes in facilitating the tabletop included clarity and design of the exercise, adequate logistics, an appropriate number of participants and facilitators, not deviating from the master scenario events list (MSEL), real-time translation, collaboration from various stakeholders, adaptability and flexibility of facilitators, and a well coordinated emergency operations center. Challenges in facilitating the tabletop included language barriers, facilitators’ lack of familiarity with the host country’s response system, perceived bias that affected communication, lack of communication method between facilitators, lack of pre-exercise introductions, and post exercise debrief role confusion. International multi-agency tabletop exercises pose unique challenges. The successful completion of these exercises is dependent on early and comprehensive planning, a thorough understanding of the stakeholder capabilities, clear and concrete objectives, adequate translation capabilities, good pre- and post-exercise follow up, and facilitator flexibility and adaptability.