[Date][Date]

Jurisdiction specific opening montage

[Jurisdiction Lead Planner][Jurisdiction Lead Planner]

WELCOME AND OPENING

COMMENTS

WELCOME AND OPENING

COMMENTS

BIOLOGICAL WEAPONS OVERVIEW

BIOLOGICAL WEAPONS OVERVIEW

Biological warfare or biological terrorism includes the use of

microorganisms (bacteria or viruses),

toxins, or fungi to produce death or

disease in humans, animals, and plants

DEFINITION

HISTORY OF USE

• Sporadic use throughout recorded history

• British use of smallpox in 1700s• Japanese use in WWII• Soviet / US offensive programs• Sverdlovsk, USSR – 1979• Iraqi BW program

RECENT BIOTERRORISM ACTIVITY

– 1984: Rajneesh cult uses Salmonella in Portland, Oregon

– 1991: Members of the Minnesota Patriot’s Council plan to use ricin against local officials

– 1994: Aum Shinrikyo attempts multiple biologicalattacks in and around Tokyo

– 1995: Thomas Lavy, Arkansas farmer, acquires ricin

– 1995: Larry Wayne Harris illegally obtains cultures of

bubonic plague– 1997: Anthrax/plague hoax at B’nai Brith

headquarters in Washington, DC– 1998: Two individuals apprehended in Las Vegas

with non-lethal strain of anthrax– 1998 to

Present: Anthrax cases and hoaxes and nationwide

ANTHRAX CASESANTHRAX CASES

Fall 200123 total anthrax infections • 5 deaths from inhalation infections • 11 cases inhalation infections • 12 cases cutaneous anthrax

Fall 200123 total anthrax infections • 5 deaths from inhalation infections • 11 cases inhalation infections • 12 cases cutaneous anthrax

2001Sept. 18 - Daschle and NBC letters postmarked in Trenton, N.J.Oct. 4 - Robert Stevens diagnosed with anthrax infection in FL. He dies the next day.Oct. 12 - An NBC News employee in New York is diagnosed with cutaneous anthrax. The female employee had been treated with Cipro since Oct. 1.Oct. 15 - Daschle letter tests positive for anthrax. Oct. 22 - American Media headquarters in FL declared a Superfund site. Oct. 23 - Authorities confirmed anthrax killed two postal workers from the Brentwood

postal facility in DCOct. 30 - A Bronx woman is seriously ill with New York's first confirmed case of

inhalation anthrax. She dies the next day.Nov. 2 - Anthrax appears in India, Pakistan.Nov. 6 - A diplomatic mailbag at the U.S. Consulate in Yekaterinburg, Russia tests

positive for anthrax spores. Nov. 21 - Elderly woman from CT dies from inhalation anthrax.

WHY USE BIOLOGICAL WEAPONS WHY USE BIOLOGICAL WEAPONS

• Relatively easy to acquire, produce, and hide

• Relatively inexpensive to produce and disseminate

• Delayed reaction allows escape or disassociation

• Potentially devastating in small quantities

• Difficult to detect (until it is too late)

• Relatively easy to acquire, produce, and hide

• Relatively inexpensive to produce and disseminate

• Delayed reaction allows escape or disassociation

• Potentially devastating in small quantities

• Difficult to detect (until it is too late)

EXERCISE OVERVIEWEXERCISE OVERVIEW

To provide participantswith an opportunity toexercise current concepts, plans, and capabilities for response to a public health emergency resulting from a biological terrorism incident

PURPOSE

SurveillanceSurveillanceEpidemiological

Investigation

Epidemiological

Investigation

DiagnosisDiagnosis Resources &

Capabilities

Resources &

Capabilities

SCOPESCOPE

DOMESTIC INCIDENT MANAGEMENT OF

BIOLOGICAL TERRORISM

DOMESTIC INCIDENT MANAGEMENT OF

BIOLOGICAL TERRORISM

DESIGN OBJECTIVES

• Insert Jurisdiction specific objectives

EXERCISE STRUCTURE

• Module 3 –

• Module 1 –• Module 2 –

HOW MODULES ARE CONDUCTED

Situation UpdateSituation Update

[Situation Manual Cover Page]

SITUATION MANUAL

Introduction

Modules

Questions

Appendices

After-Action Report

Evaluation Forms

[Situation Manual Cover Page]

HOW MODULES ARE CONDUCTED

Spokesperson designated to present summarySpokesperson designated to present summary

Caucus PeriodCaucus PeriodFacilitated DiscussionFacilitated Discussion

Situation UpdateSituation Update

[Situation Manual Cover Page]

FUNCTIONAL RESPONSE GROUPSFUNCTIONAL RESPONSE GROUPS

Public Health

Emergency Management

Hospital Incident Command

Infection Control/Healthcare Providers

Public Safety

Public Information

ROLES & RESPONSIBILITIES

PlayersPlayers ObserversObservers

Organized by functional area

Talk between the tables is encouraged

Organized by functional area

Talk between the tables is encouraged

Can move between tables

Can be used as a resource by Players

Can move between tables

Can be used as a resource by Players

Moderate the flow of discussion

Local community policy experts

Moderate the flow of discussion

Local community policy experts

Not a functional or command post exercise, but a facilitated discussion Not a functional or command post exercise, but a facilitated discussion FacilitatorsFacilitators

ASSUMPTIONS & ARTIFICIALITIES

• The scenario is plausible; events occur as they are presented

• Certain biological agent aspects are idealized

• All participants receive information at the same time

Fight the problems, not the scenario

There Is No School Solution

Agree to Disagree

There Is No School Solution

Agree to Disagree

Don’t Limit Yourself

Decisions Don’t Set Precedents

Don’t Limit Yourself

Decisions Don’t Set Precedents

No-Fault, Low-Threat EnvironmentNo-Fault, Low-Threat Environment

Acronym-Free EnvironmentAcronym-Free Environment

EXERCISE RULES

ADMINISTRIVIA

• Phones, pagers, radios

• Bathrooms

• Lunch

• Breaks

• Badges

• Evaluation Forms

• Additional Resources

EXERCISE SCHEDULE

[Time] Registration

[Time] Welcome and

Introductions

[Time] INCUBATION

[Time] INITIAL RESPONSE

[Time] Working Lunch

[Time] RESPONSE and RECOVERY

[Time] Review and Conclusion

[Time] Closing CommentsHotwash with planning committee immediately following exerciseHotwash with planning committee immediately following exercise

BEGIN EXERCISE

BEGIN EXERCISE

MODULE 1

INCUBATION

MODULE 1

INCUBATION

• Government agencies continue to monitor threats against Americans at home and abroad

• Threats of biological attacks increase fears of terrorism

• Citizens are wary of additional attacks on U.S. soil

GENERAL INFORMATION

MonthYear

• Many patients present at healthcare facilities throughout [Jurisdiction] with flu-like symptoms

• The number of flu cases is unusually high even for this time of year

• A 63-year-old male patient with 104 F fever, cough, and headache is seen at [Local hospital]

• He is instructed to rest, drink plenty of fluids, and return if symptoms persist

CASE STUDY #1

DayDateTime

• By lunchtime, 9-1-1 personnel notice an increase in calls from patients with flu-like symptoms

• Many patients are sent home with instructions to return if symptoms worsen

• Severe cases are admitted to area hospitals for treatment and observation

ILLNESSES INCREASE

DayDateTime

• A 19-year-old male student at [Local College] reports to the [Local College Health Center]

• He has a high fever, severe headache, difficulty breathing, and a persistent cough

• The student’s symptoms have been worsening throughout the day

• Due to the severity of the symptoms, clinic staff decide to call an ambulance

CASE STUDY #2

DayDateTime

• Just after [Time of Day], the student arrives at the [Local hospital] emergency department (ED)

• The patient reports he has been coughing since Sunday night and recently began experiencing difficulty breathing

• Cultures, stains, and blood tests are ordered

• The patient is admitted to the intensive care unit (ICU)

STUDENT TRANSPORTED

DayDateTime

• A 21-year-old female is transported to [Local hospital] after experiencing shortness of breath and chest pain

• She dies of respiratory failure in the ICU

• She had attended a sorority social, [Local attraction], and church over the weekend

CASE STUDY #3

DayDateTime

• Newsrooms throughout Riverside review the events over the last 24 hours

• Local news services note high levels of activity at area hospitals

• Reporters begin checking with their public safety, health, and medical contacts

MEDIA TAKES NOTICE

DayDateTime

• The condition of the 63-year-old male, previously treated at [Local hospital], deteriorates and he is admitted

• A chest x-ray shows lobe consolidation and some infiltrates

• Due to many patients experiencing similar symptoms, the physician orders blood and sputum cultures

PATIENT DETERIORATES

DayMonthTime

• Despite antibiotic therapy, the patient becomes comatose and is moved to the ICU

• A case report is completed on the 63-year-old patient

• Doctors learn that over the weekend, he attended the [Local event], a banquet at [Venue], and went to a restaurant with his family

PATIENT’S ACTIVITIES

DayDateTime

• Infection Control Practitioners at local hospitals contact the [Local Public Health Dept.] to report the trend

• Hospitals continue collecting and processing clinical specimens

• Test results are still pending from blood and sputum cultures

CONTACTS MADE

DayDateTime

CASE STUDY UPDATECASE STUDY UPDATE

• The 19-year-old male patient admitted to [Local hospital] experiences respiratory failure and circulatory collapse; he dies at [Time of Day]

• The attending physician requests an autopsy

• Over the weekend, his girlfriend visited from the [College]; they attended [Local College] events, entertainment activities, and a movie

DayDateTime

• Respiratory specialists note a rise in consultation requests

• Clinical nursing staffs throughout [Jurisdiction] report that several earlier admitted patients have died within past 24 hours

• [Local] surveillance indicates an increase in flu and respiratory symptoms

CONCERNS INCREASE

DayDatetime

• [Public Health] continues to receive calls regarding patients with similar respiratory symptoms who are not responding to therapy

• Preliminary test results indicate a bacterial infection

• [Public Health] and the [State Public Health] are collaborating to identify and analyze clinical specimens

MEDICAL INTELLIGENCE

DayDateTime

• [Public Health] is developing a case definition

• [Public Health] reports that almost [#] patients require ICU attention

• Due to the limited number of ICU facilities, local hospitals and clinics find it difficult to place additional patients in need of critical care

• Hospitals throughout the county consider worst-case scenarios as well as disaster plan activation

HEALTHCARE EMERGENCY

DayDateTime

CASE STUDY #4CASE STUDY #4

• A 45-year-old male is transported to [Local Hospital] in cardiac arrest; he is pronounced dead at [Time of Day]

• He was a [Local PD] officer and became ill late Sunday with symptoms including difficulty breathing, severe cough, fever, and chills

• Over the weekend, he took his kids to a movie, [Venue], and a church gathering

• The attending physician requests a post-mortem exam to determine the cause of death

DayDateTime

NEW “BUG” REPORTEDNEW “BUG” REPORTED

• Reporters follow up earlier inquiries regarding the increase in patients and deaths

• News bulletins begin reporting on Riverside’s new deadly “bug”

• News commentators discuss links to other diseases and the possibility of bioterrorism

DayDateTime

Deadly Bug Deadly Bug

CONCERN ESCALATES CONCERN ESCALATES

DayDateTime

• Casualty numbers continue to rise; dispatchers have received almost triple the usual number of calls in the last 24 hours

• [Mayor] confers with [Official] and other elected officials, senior emergency management, and public health officials

• The Emergency Services Coordinator begins to determine [Jurisdiction] needs and requests outside resources

• The [Mayor] orders the activation of the [EOC]

RESOURCES STRETCHED RESOURCES STRETCHED

DayDateTime

• Constant news reports on the new “mystery” disease prompt citizens to inundate 9-1-1 and line up at hospital EDs and clinics as far away as [Other communities]

• EMS providers and hospital personnel are becoming symptomatic

• Hospitals and clinics request additional security; however, law enforcement agencies are experiencing high absenteeism

* Report as of Day, Date, Time

CASUALTY SUMMARY*CASUALTY SUMMARY*

Total Presenting: [#]

Currently Hospitalized [#]

Deceased [#]

Examined and Released/Monitored [#]

Total Presenting: [#]

Currently Hospitalized [#]

Deceased [#]

Examined and Released/Monitored [#]

KEY ISSUES

• Fire and EMS runs have tripled• Hospitals are inundated with patients presenting

with flu-like symptoms and ICU beds are at full capacity

• Clinical specimens continue to be collected and processed; preliminary blood tests and cultures indicate bacterial infections

• Community anxiety is fueled by intense media coverage

• Hospitals request law enforcement assistance with security

• The [Jurisdiction EOC] is activated

CAUCUS PERIODCAUCUS PERIOD

FACILITATED DISCUSSIONFACILITATED DISCUSSION

MODULE 2INITIAL

RESPONSE

MODULE 2INITIAL

RESPONSE

• Media sources are seeking new information about the crisis

• Media personnel question the adequacy of local agencies and hospitals to protect citizens

• National news stories feature the unexplained “epidemic” in [Jurisdiction]

• Local medical supplies run short

• Some citizens shelter at home; others are fleeing from the area

MEDIA FRENZYMEDIA FRENZY

DayDateTime

VICTIM UPDATEVICTIM UPDATE

DayDateTime

• A dramatic increase in deaths attributed to the epidemic occurs throughout the day

• Reports to the [Public Health Dept.] and the city and county EOCs indicate more than [#] have died and hundreds more are seeking treatment

• Public safety agencies are fearful that transporting patients may expose personnel to potential infection

• Healthcare providers and facilities continue to be overwhelmed

ADDITIONAL REQUESTSADDITIONAL REQUESTS

• Hospitals and private healthcare providers report the number of asymptomatic patients continues to increase

• Requests for assistance continue to be sent to the city and county EOCs

DayDatetime

PRELIMINARY IDENTIFICATION PRELIMINARY IDENTIFICATION • Laboratory testing and autopsy results

provide a presumptive identification of Yersinia pestis

• The [Public Health Official] is notified

• Local response agency personnel convene to discuss recent findings

• [State Public Health] notifies the CDC of the preliminary test results

• Strategies for requesting and receiving pharmaceutical and materials from the Strategic National Stockpile (SNS) are considered

DayDateTime

• Local officials suspect the outbreak may be the result of a deliberate release

• Health officials confer with law enforcement

• Notifications are made to the Federal Bureau of Investigation (FBI) [Field Office]

• Key Federal departments and agencies review elements of the U.S. Government Interagency Domestic Terrorism Concept of Operations Plan (CONPLAN)

DELIBERATE ATTACK?

DayDatetime

LOCAL RESPONSELOCAL RESPONSE• Response agencies and personnel are

overwhelmed by the worried well

• The Operational Area contacts surrounding jurisdictions for assistance

• The Mayor and other policy-level personnel meet to discuss the situation

• [Local Official] signs an emergency declaration and informs the EOC; State and Federal resources are identified

DayDatetime

EPI INVESTIGATION EPI INVESTIGATION

• Reports indicate approximately [#] deaths and [#] symptomatic and hospitalized

• Illness and absenteeism among first responders and healthcare providers continues to rise

• The preliminary epidemiological investigation indicates many of the patients were at the [Venue]

• There is evidence of secondary infection

DayDateTime

PUBLIC HEALTH RESPONSEPUBLIC HEALTH RESPONSE

• [Public Health], [State Public Health], and CDC continue the epidemiological investigation to identify initial and secondary exposures

• Isolation and quarantine issues are discussed

• Public health officials express concern regarding the unavailability of hospital beds and medical and pharmaceutical supplies

DayDateTime

STATE OF EMERGENCY STATE OF EMERGENCY • On the advice of senior State

officials, [Governor] declares a state of emergency

• The Governor requests a Federal declaration, including the activation of the NDMS, SNS, and deployment of specialized Federal assets such as DMATs and DMORTs

• Officials confirm new cases are a result of secondary exposure

DayDateTime

• The Attorney General and USDHS Secretary brief the President

• President Bush reassures [State] residents and the Nation of Federal support

• Activation of the Federal Response Plan (FRP) is directed

• CDC requests and disseminates information across the Nation

• The World Health Organization (WHO) is notified of the pneumonic plague outbreak

FEDERAL ASSETSFEDERAL ASSETS

DayDateTime

• The [Terrorist Group] claims responsibility for releasing Yersinia pestis at Castle Park

• Law enforcement personnel face challenges while investigating these claims

• The attack receives international media attention

• Security measures are augmented at critical infrastructure sites and major businesses throughout [State]

CLAIM OF RESPONSIBILITY CLAIM OF RESPONSIBILITY

DayDateTime

CONTINUING RESPONSECONTINUING RESPONSE• Elected officials are under pressure

from an angry and concerned public to resolve the crisis

• Law enforcement and epidemiological personnel work together to investigate the attack

• Federal consequence management personnel arrive in [Jurisdiction] and begin coordinating Disaster Field Office (DFO) operations

DayDateTime

BIOTERRORISM BIOTERRORISM • The bioterrorism attack remains a

national media event• Hundreds of people still await

examination and processing• Additional cases are now being

investigated in surrounding counties, [surrounding communities]

• Demand for antibiotics exceeds available supplies

• Medical and response personnel are exhausted and first responder absenteeism remains high

DayDatetime

AGENT CONFIRMATION AGENT CONFIRMATION • [Laboratory] confirms Yersinia

pestis as the causative agent in patients throughout [Jurisdiction]

• Potential plague cases are present in [surrounding communities]

• The White House is briefed on the situation, including the Federal assets that will assist [Jurisdiction] response effort

• The FBI brief the other Federal agencies on the status of the investigation

DayDateTime

INVESTIGATIVE FOCUSINVESTIGATIVE FOCUS• Federal, State, and local agencies

focus the epidemiological and criminal investigation on [Venue]

• Hospital records and samples are scrutinized for possible evidence

• Investigators are focused on locating everyone who was at [Venue] on [Date]

• Public safety and public health officials note the area surrounding [Venue] will remain closed indefinitely for investigation

DayDatetime

• An aggressive public information campaign is implemented to alleviate public fears

• Despite the decrease in new cases, citizens continue to flee the area

• DMATs, DMORTs, and other Federal assets arrive to assist the local response

• DMORTs assists the Coroner in handling the deceased

• The American Red Cross assists those affected by the incident

FEDERAL RESPONSEFEDERAL RESPONSE

DayDatetime

* Report as of Day, Date, Time

CASUALTY SUMMARY*CASUALTY SUMMARY*

Total Confirmed Cases: [#]

Currently Hospitalized [#]

Total Deceased [#]

Deaths in Last 24 Hours [#]

Total Worried Well: [#]

Worried Well in Last 24 Hours [#]

Total Confirmed Cases: [#]

Currently Hospitalized [#]

Total Deceased [#]

Deaths in Last 24 Hours [#]

Total Worried Well: [#]

Worried Well in Last 24 Hours [#]

KEY ISSUES

• [Laboratory] confirms Yersinia pestis as the infecting agent

• A terrorist group claims responsibility for releasing the agent

• State and local emergencies are declared• The number of worried well presenting at

hospitals continues to increase• The investigation focuses on the [Venue]• The NDMS is activated, and DMATs and DMORTs

are deployed

CAUCUS PERIODCAUCUS PERIOD

FACILITATED DISCUSSIONFACILITATED DISCUSSION

MODULE 3RESPONSE & RECOVERY

MODULE 3RESPONSE & RECOVERY

• The full impact of the attack is still unfolding as resources continue to flow into the area

• Large quantities of supplies sit unused as relief agencies are inundated with donations

• Volunteers who spontaneously appeared to aid in the response become frustrated as they are not fully integrated into operations

ASSETS AND SUPPLIESASSETS AND SUPPLIES

DayDate

• Since the initial identification of the plague on [Date], the number of new deaths has dropped

• Media coverage is constant and local agencies are challenged by requests for information

• Other metropolitan areas across the country are closely monitoring the response effort and have implemented stringent security and medical surveillance measures

MONITORING CONTINUESMONITORING CONTINUES

DayDate

ECONOMIC CONSIDERATIONS

ECONOMIC CONSIDERATIONS

DayDate

• Previously scheduled events throughout [Jurisdiction] are canceled or postponed

• Hotels, restaurants, farmers, and other businesses and industries are forced to lay off hundreds in [region of State]

• Private and commercial sectors experience severe short-term and long-term economic losses

• Psychological effects of the terrorist event are widespread

• Public unease remains high as victims and first responders are showing signs of post-traumatic stress disorder (PTSD)

• The American Red Cross, [State Public Health], and [Public Health] are providing support to victims

VICTIM CONCERNSVICTIM CONCERNS

DayDate

• Federal, State, and local vector control and animal services agencies continue monitoring the stray and wild animal population

• Vector control specialists brief Federal, State, and local health officials on prevention and control plans

VECTOR CONTROLVECTOR CONTROL

DayDate

• Federal, State, and local leaders are attempting to bring closure to the incident

• Long-term management of surviving victims and the psychological effects are difficult issues facing officials

• A criminal investigation of broad scope and urgency is under way

• Physical evidence is collected and interviews are conducted

RECOVERY CONTINUESRECOVERY CONTINUES

DayDate

• City and county officials and department heads are briefed on plans for continuing long-term assistance

• Disaster Field Office operations continue

• Small business owners and family farmers are filing for bankruptcy

• Representatives from the local community colleges and universities raise concerns regarding the security of facilities

COMMUNITY RECOVERYCOMMUNITY RECOVERY

DayDate

• Officials determine the plague released on [Date] no longer poses a widespread threat

• Local business owners express frustration about being forbidden from reopening facilities

• Many government officials, congressional representatives, and other dignitaries plan visits to California, further burdening local law enforcement

OFFICIAL PRESENCEOFFICIAL PRESENCE

DayDate

• Several agencies are monitoring post-traumatic stress disorder (PTSD) and critical incident stress management (CISM) programs

• Local organizations are receiving an overwhelming number of requests for information, counseling, and employee assistance

COUNSELING AND RECOVERY COUNSELING AND RECOVERY

DayDate

MEMORIAL SERVICESMEMORIAL SERVICES

President Bush and local officials participate in memorial

services

DayDate

CASUALTY SUMMARYCASUALTY SUMMARY

Total Confirmed Cases: [#]

Total Deceased [#]

Survivors [#]

Total Worried Well: [#]

Total Confirmed Cases: [#]

Total Deceased [#]

Survivors [#]

Total Worried Well: [#]

KEY ISSUES

• Resources continue to flow into the area and relief agencies are inundated with donations

• Events have been canceled or postponed throughout Riverside

• Vector control specialists implement eradication and control programs

• Criminal investigation continues• Mental health agencies are overwhelmed with

requests for counseling• Economic impact on business community is

mounting• Memorial services are conducted

CAUCUS PERIODCAUCUS PERIOD

FACILITATED DISCUSSIONFACILITATED DISCUSSION

DESIGN OBJECTIVES

• Insert jurisdiction specific objectives

WHAT’S NEXT?

WHAT’S NEXT?

Closing CommentsClosing Comments