Exercise Esplanade:Integrating tabletop and mannequin-based simulation for emergency department mass casualty training

To ensure readiness for mass casualty incidents, emergency department clinicians must be trained in key disaster response principles, including resource allocation and interdepartmental coordination. Traditional simulation modalities used to educate staff in this area come with limitations. While mannequin-based simulation provides hands-on experience, it is impractical at scale. Tabletop exercises facilitate strategic decision-making but may lack immersion. Virtual simulation often requires additional resources and an information technology skillset beyond many simulation educators. This article describes Exercise Esplanade , a novel hybrid simulation-based training program integrating tabletop and mannequin-based modalities to enhance preparedness for emergency department clinicians at a single tertiary site. Thirty-one emergency clinicians participated in the four-hour session. Learners were able to familiarise themselves with the emergency department's Code Brown sub-plan and how to prepare and receive large numbers of casualties during the tabletop exercise. Mannequin-based simulation enabled participants to simultaneously manage two critically injured burns patients, practising clinical prioritisation and resource allocation in an immersive format. A post-exercise questionnaire indicated strong participant engagement, with all respondents rating the exercise as valuable, clinically relevant, and impactful on patient safety. The exercise enabled review of the sub-plan and detection of latent safety threats, resulting in revisions to the document. The integration of tabletop and mannequin-based simulation offers a scalable, cost-effective approach to mass casualty incident education for those already conducting simulation activities at their site. This collaborative model balances theoretical learning with hands-on experience, with no disruption to service delivery. Exercise Esplanade as a replicable training method applicable across various pandemic and disaster preparedness contexts.