JMIR Publications

ABSTRACT

Background:

Tabletop exercises (TTXs) are increasingly used to strengthen prehospital preparedness for mass casualty incidents (MCIs), yet evidence on their design, facilitation, and evaluation remains dispersed. Existing reviews address tabletop simulation broadly but do not isolate the prehospital MCI interface or examine whether evaluation methods align with exercise purpose.

Objective:

This scoping review mapped how TTXs have been designed, facilitated, and evaluated in prehospital MCI preparedness; classified outcomes using Kirkpatrick’s Evaluation Model; and identified patterns linking exercise purpose, facilitation, frameworks, and evaluation depth.

Methods:

We conducted a scoping review using Arksey and O’Malley’s framework, Levac et al’s refinements, and PRISMA-ScR and PRISMA-S guidance. PubMed, Embase, Scopus, PsycINFO, CINAHL, the Cochrane Library, ClinicalTrials.gov, Google Scholar, and reference lists were searched for English-language peer-reviewed or grey literature published from 2015 through May 2026. Eligible studies evaluated TTXs in prehospital disaster or MCI preparedness and reported measurable educational, clinical, or system outcomes. Two reviewers independently screened records, extracted data, and classified outcomes using Kirkpatrick’s levels, with an added Level 2+ Applied Learning category for structured performance assessment within the exercise environment.

Results:

Thirteen studies from nine countries were included. Studies were organized into a preliminary TTX Design Spectrum: Tier 1 Algorithm Rehearsal (n=2), focused on protocol-specific triage performance; Tier 2 Scenario-Based Decision Training (n=7), focused on multidisciplinary decision-making under realistic constraints; and Tier 3 Systems Integration Testing (n=4), focused on interagency coordination and system-level preparedness. Five primary facilitation modes were identified: Standardization Agent, Instructional Guide, Performance Coach, Expert-Led, and Multidisciplinary. Evaluation was concentrated at Kirkpatrick Level 1 Reaction (n=10), Level 2 Learning (n=11), and Level 2+ Applied Learning (n=8), with fewer studies assessing Level 3 Behavior (n=2) or Level 4 Results (n=3). Operational frameworks were reported more consistently than formal educational design or assessment frameworks. Natural-disaster scenarios and evidence from resource-limited settings were underrepresented.

Conclusions:

TTXs for prehospital MCI preparedness should be understood as a family of related exercise types rather than a single uniform intervention. This review contributes a preliminary conceptual framework, including the TTX Design Spectrum, Level 2+ Applied Learning, and Evaluation Depth Disparity, to support alignment among exercise purpose, facilitation, frameworks, and evaluation strategy. Future research should validate these constructs, improve follow-up assessment of behavioral transfer, and expand TTX design to natural-disaster and resource-limited contexts.