Tabletop Exercises to Assess Prehospital Preparedness: A Scoping Review Protocol

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 TTXs in prehospital settings, specifically their impact on preparedness activities leading up to hospital admission, remains underexplored. This scoping review aims to map how TTXs have been utilized to assess and improve prehospital preparedness, identify outcome measures aligned with the Kirkpatrick Model, and explore the characteristics and contexts of these exercises. Methods: This scoping review is conducted as part of the MCI-PHER project (Mass Casualty Incident – Prehospital Emergency Response), a collaborative initiative to advance disaster medicine education and prehospital preparedness. The review will follow Arksey and O’Malley’s five-stage framework, enhanced by Levac et al., and report according to PRISMA-ScR guidelines. A comprehensive search of databases, including PubMed, Scopus, Embase, PsycINFO, CINAHL, Cochrane, and ClinicalTrials.gov, along with gray literature from Google Scholar, will be conducted. Eligible studies will include TTXs used in prehospital or EMS-related emergency preparedness, across all primary study designs. The outcomes will be mapped to the four levels of the Kirkpatrick Model. Two independent reviewers will conduct study selection, data extraction, and quality checks, with disagreements resolved by a third reviewer. Data will be charted using a customized extraction tool, refined through piloting five relevant studies. Results and Analysis: The scoping review will synthesize and map the evidence on the use of tabletop exercises (TTXs) in prehospital emergency preparedness. Findings will be organized and presented in tables, figures, and other visual formats to provide a structured overview. Studies will be categorized according to their focus and objectives, educational or training context, target populations, TTX characteristics, and reported outcomes. Quantitative data (e.g., frequencies, sample sizes, outcome measures) will be summarized descriptively, while qualitative evidence (e.g., participant experiences, lessons learned) will be analyzed narratively to capture contextual insights. This comprehensive synthesis will highlight current practices, underexplored areas, and evidence gaps to inform future research and guide the development of effective training strategies for prehospital emergency preparedness. Dissemination and Ethics: No ethical approval is required as no human subjects are involved. Findings will be disseminated through peer-reviewed publications, conference presentations, policy briefs, and stakeholder engagement.