TWENTYNINE PALMS, Calif. — Navy Medicine Readiness and Training Command (NMRTC) Twentynine Palms conducted an influenza pandemic tabletop exercise on April 9, 2026 to evaluate the command’s ability to respond to a large-scale public health emergency while maintaining support to warfighters, beneficiaries, and the operational mission at Marine Corps Air Ground Combat Center Twentynine Palms.
The discussion-based exercise centered on a hypothetical H7N3 avian influenza virus that evolved the ability to spread from human to human similarly to seasonal influenza, forcing hospital leadership and staff to navigate increasingly complex operational and medical challenges as the simulated pandemic intensified.
Participants from across the command worked through how NMRTC Twentynine Palms would activate and sustain emergency operations under the Hospital Incident Command System (HICS), while coordinating with military and civilian partners throughout the region. The exercise brought together clinical and administrative personnel to evaluate emergency response plans, identify gaps, and strengthen long-term readiness for future crises.
“A tabletop exercise is a discussion-based session where people are walked through a hypothetical scenario,” said environmental health officer Lt. j.g. David Naiman, who serves as the command’s preventive medicine department head. “Participants discuss the roles they assume and the measures they would take in response. The goal of this is to improve knowledge of emergency plans and identify weak points.”
According to Naiman, the exercise focused not only on responding to a fast-moving infectious disease outbreak, but also on building a culture of proactive preparedness throughout the command.
“Ultimately, the most critical objective achieved by this tabletop exercise is cultivating an environment for proactive discussion and forward-thinking analysis,” Naiman said. “While the reality of future pandemics is a challenging subject, treating the next event as a certainty rather than a possibility is foundational to building our operational readiness and response capabilities.”
As the scenario evolved, leadership and staff were challenged to manage patient surges, staffing shortages, infection risks to healthcare personnel, limited inpatient capacity, and the possibility that outside medical facilities could face the same strain simultaneously.
“This scenario provided valuable insights into managing complex operational challenges, such as navigating non-specific patient symptoms, protecting our dedicated emergency department (ED) corpsmen from infection risks, and creatively addressing bed and staffing constraints,” Naiman said.
The exercise also examined how the command would operate if patient diversion to regional military and civilian hospitals became limited or unavailable during a widespread emergency.
“While our established diversion protocols with Naval Hospital Camp Pendleton, Naval Medical Center San Diego, and nearby civilian network facilities remain important assets, this exercise highlighted a vital opportunity to strengthen our organic resilience,” Naiman said. “Since widespread events like a global pandemic can simultaneously strain healthcare resources across all regions, it is paramount that we proactively plan for scenarios where immediate diversion may not be possible.”
The simulated response required participants to determine when to notify command leadership and public health personnel and transition from routine operations into an organized emergency response posture.
“The team successfully recognized the trigger to contact the CO (commanding officer), PHEO (Public Health Emergency Officer), and APHEO (Alternate Public Health Emergency Officer) and establish the Hospital Incident Command System,” Naiman said. “This swift activation is a critical component of proper emergency planning, as it shifts the facility from routine operations into a structured, proactive response posture capable of handling complex public health emergencies.”
Naiman said the command intentionally included representatives from departments across the organization to ensure the exercise reflected both the medical and operational realities of a pandemic response.
“Our selection process aimed to build a comprehensive team, so we included representatives from all departments that intersect with pandemic influenza response,” Naiman said. “By bringing both clinical and administrative leaders to the table, we were able to bridge the gap between medical strategy and operational execution.”
Throughout the exercise, several areas for improvement emerged, particularly in staffing representation, emergency planning, and long-term sustainment capabilities.
“Our primary learning opportunities are centered on staffing representation and operational planning,” Naiman said. “Moving forward, integrating more frontline providers and nurses alongside ED leadership will provide a more realistic operational picture.”
The exercise also highlighted the realities of operating in an austere environment with limited inpatient capacity and staffing resources during a prolonged emergency.
“The exercise starkly highlighted our facility's minimal organic staffing and limited bed capacity, which severely restricted our ability to sustain long-term inpatient services during a prolonged crisis,” Naiman said.
Additional discussion points included the need for structured decedent affairs planning, maintaining sufficient protective equipment, and developing stronger diversion plans to support continuity of care during a major public health emergency.
Despite the challenges identified, Naiman said the exercise demonstrated several strengths within the command’s existing emergency response framework.
“Our primary successes centered on swift protocol execution and robust inter-agency teamwork,” Naiman said. “They discussed how to promptly notify preventive medicine and accurately execute reporting procedures for both military and civilian authorities.”
He added that collaboration between internal departments, installation emergency management personnel, and regional civilian partners played a significant role in strengthening the overall response effort.
The exercise directly supported the command’s broader mission of ensuring medical readiness and maintaining healthcare services during operational disruptions.
“The tabletop exercise allows for the hospital to be prepared for a pandemic emergency so that services and support for the warfighters’ mission continues uninterrupted to the greatest extent possible,” Naiman said. “The goals here are to minimize spread and care for those who do get infected until pharmaceutical solutions such as antivirals or vaccines become available.”
Naiman said future exercises may expand into other emergency scenarios, including earthquakes, floods, chemical incidents, biowarfare events, or full-scale functional exercises involving simulated casualties presenting for treatment in real time.
For personnel and beneficiaries, he emphasized that the exercise reflects NMRTC Twentynine Palms’ commitment to readiness and proactive emergency planning.
“The key takeaway is that NMRTC Twentynine Palms is deeply committed to proactive preparedness,” Naiman said. “Tabletop exercises are vital tools that enhance our overall readiness by allowing us to stress-test our planning and elevate our staff's clinical and administrative competence in a controlled environment.”
By conducting realistic scenario-based training before a real-world crisis occurs, Naiman said the command is building the coordination, communication, and confidence necessary to respond effectively when needed most.
“We do this hard work now so that, should an emergency ever arise, our patients and staff can trust that our response will be swift, unified, and highly effective,” Naiman said.
| Date Taken: |
05.08.2026 |
| Date Posted: |
05.08.2026 18:24 |
| Story ID: |
564862 |
| Location: |
TWENTYNINE PALMS, CALIFORNIA, US |
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