A Stepwise Approach to Emergency Management Exercises

You’ve completed your annual Hazard Vulnerability Analysis (HVA)—an important milestone and a required condition of participation for CMS. With that box checked, the next challenge begins: addressing the high-ranking hazards identified in the HVA and translating risk awareness into meaningful preparedness.

For many facilities, one of the highest-rated—and most complex—risks is an active assailant incident. Emergency management professionals who are new to the role may feel compelled to immediately conduct a full-scale exercise to address this top concern. A complex solution to a complex risk. However, it is worth pausing to consider whether that approach is the most effective starting point.

Why a Stepwise Exercise Design Matters

Emergency management exercise design is intentionally structured as a progressive, stepwise process. The goal is to build capability and capacity over time, leading up to increasingly complex exercises such as full-scale events involving multiple participants, external agencies, and scenarios that may have significant psychological impacts on staff.

Rather than starting at the highest level of complexity, many organizations benefit from beginning with smaller, more focused exercises and building upward as skills, confidence, and systems mature.

Step One: Small-Scale Envelope Drills

Envelope drills offer a low-pressure, high-value entry point for exercising complex hazards. These small-scale exercises allow staff to work through a scenario in a condensed timeframe using their existing knowledge, policies, and tools—without a facilitator guiding every decision.

Envelope drills can be conducted across departments and shifts, making them flexible and inclusive. More importantly, they provide insight into how staff naturally interpret and apply procedures. The outcomes of these drills often highlight practical strengths and gaps, which can then be addressed through targeted training or policy revisions.

Step Two: Tabletop Exercises

Once foundational concepts and processes have been exercised and refined, organizations may be ready to progress to a tabletop exercise. Tabletops typically involve a larger, cross-functional group from the facility and allow participants to work through a similar scenario in greater depth and over a longer timeframe.

These exercises are intentionally “low drag,” relying on existing staff, policies, and organizational structures. Tabletops help identify how different departments coordinate, communicate, and make decisions during a threat scenario. As with envelope drills, the focus should remain on identifying strengths, gaps, and opportunities for improvement—followed by updates to plans and training.

Step Three: Full-Scale Exercises

By the time an organization reaches a full-scale exercise, it should have already developed a baseline level of preparedness. Staff are more familiar with processes, leaders better understand their roles, and procedures have been tested and refined through earlier exercises.

At this stage, a full-scale exercise becomes a validation of capability rather than a discovery of foundational gaps. The organization is better positioned to succeed—and to gain meaningful value from the complexity of the event.

The Risk of Skipping Steps

Jumping directly into a full-scale exercise can carry unintended consequences. When an after-action report identifies an overwhelming number of improvement items, it may signal that the scope exceeded the organization’s current level of readiness. This can erode staff confidence and leave leaders feeling unprepared or discouraged.

Emergency management is not about rapidly checking tasks off a list. It is a continuous cycle of planning, exercising, evaluating, and improving to achieve and sustain readiness.

Healthcare already embraces this mindset in other areas—such as reducing falls, medication errors, and healthcare-associated infections. Each of these relies on incremental process improvement and refinement. Emergency management exercises mirror the same philosophy.

Moving Forward

A thoughtful, stepwise approach to exercises allows organizations to build resilience in a deliberate and sustainable way. If you need support in addressing high-ranking hazards identified in your HVA—through exercises, training, or planning—please reach out to a member of the emergency management team. We’re here to help you move from assessment to preparedness with confidence.

For more information, contact Ryan Weaver, MBA, BSN, RN, CPPS, CHEP, CFI-I Manager, Emergency Management.