1. Bioterrorism Drill Case 1 Botulism: Patient Roles

2. You are an out of town delegate to the Republican National Convention. Yesterday morning, you attended the opening buffet breakfast and then spent the day listening to speakers. This morning, you felt a little ‘off’ but as the day went on, you began feeling weak, nauseous, and things started looking blurry. After similar complaints from several people, conference organizers decided to send a busload of people to the hospital to be evaluated. You took the bus to the Emergency Department and present with: Weakness Blurry vision Nausea Abdominal cramps If asked about vital signs, please show the opposite side of this card. 1Y You are an out of town delegate to the Republican National Convention. Yesterday morning, you attended the opening buffet breakfast and then spent the day listening to speakers. This morning, you felt a little ‘off’ but as the day went on, you began feeling weak, nauseous, and things started looking blurry. After similar complaints from several people, conference organizers decided to send a busload of people to the hospital to be evaluated. You took the bus to the Emergency Department and present with: Weakness Blurry vision Nausea Abdominal cramps If asked about vital signs, please show the opposite side of this card. 1Y

3. General impression: Patient is weak. Vital Signs: Pulse: 70 Respirations: 16 BP: 130/80 Temp: 98ºF, PO Pupils: Normal General impression: Patient is weak. Vital Signs: Pulse: 70 Respirations: 16 BP: 130/80 Temp: 98ºF, PO Pupils: Normal

4. You are an out of town delegate to the Republican National Convention. Yesterday morning, you attended the opening buffet breakfast and then spent the day listening to speakers. This morning, you felt a little ‘off’ but as the day went on, you began feeling weak, nauseous, and things started looking blurry. After similar complaints from several people, conference organizers decided to send a busload of people to the hospital to be evaluated. You took the bus to the Emergency Department and present with: SEVERE Respiratory distress Profound weakness Blurry vision Nausea Abdominal cramps If asked about vital signs, please show the opposite side of this card. 1R You are an out of town delegate to the Republican National Convention. Yesterday morning, you attended the opening buffet breakfast and then spent the day listening to speakers. This morning, you felt a little ‘off’ but as the day went on, you began feeling weak, nauseous, and things started looking blurry. After similar complaints from several people, conference organizers decided to send a busload of people to the hospital to be evaluated. You took the bus to the Emergency Department and present with: SEVERE Respiratory distress Profound weakness Blurry vision Nausea Abdominal cramps If asked about vital signs, please show the opposite side of this card. 1R

5. General impression: Patient is in severe respiratory distress and is very weak. Vital Signs: Pulse: 120 Respirations: 36, shallow BP: 130/80 Temp: 98ºF, PO Pupils: Normal General impression: Patient is in severe respiratory distress and is very weak. Vital Signs: Pulse: 120 Respirations: 36, shallow BP: 130/80 Temp: 98ºF, PO Pupils: Normal

6. You are an out of town delegate to the Republican National Convention. Yesterday morning, you attended the opening buffet breakfast and then spent the day listening to speakers. This morning, you felt a little ‘off’ but as the day went on, you began feeling weak, nauseous, and things started looking blurry. After similar complaints from several people, conference organizers decided to send a busload of people to the hospital to be evaluated. You took the bus to the Emergency Department and, while being decontaminated or triaged, please sit towards the back of the group. When approached to be decontaminated, you become unresponsive and remain unresponsive for the rest of the drill. While still conscious, you present with: SEVERE Respiratory distress progressing to respiratory arrest Flaccid paralysis If asked about vital signs, please show the opposite side of this card. 1B You are an out of town delegate to the Republican National Convention. Yesterday morning, you attended the opening buffet breakfast and then spent the day listening to speakers. This morning, you felt a little ‘off’ but as the day went on, you began feeling weak, nauseous, and things started looking blurry. After similar complaints from several people, conference organizers decided to send a busload of people to the hospital to be evaluated. You took the bus to the Emergency Department and, while being decontaminated or triaged, please sit towards the back of the group. When approached to be decontaminated, you become unresponsive and remain unresponsive for the rest of the drill. While still conscious, you present with: SEVERE Respiratory distress progressing to respiratory arrest Flaccid paralysis If asked about vital signs, please show the opposite side of this card. 1B

7. General impression: Patient is unresponsive. Vital Signs: Pulse: 10 Respirations: 0 BP: 00/P Temp: 98ºF, PO Pupils: Fixed and dilated General impression: Patient is unresponsive. Vital Signs: Pulse: 10 Respirations: 0 BP: 00/P Temp: 98ºF, PO Pupils: Fixed and dilated

8. You are a reporter for FOX News covering the Republican National Convention. You just arrived in town late last night. This morning, you felt a little tired, but as the day went on, you began feeling better. After complaints from several people about not feeling well, conference organizers decided to send a busload of people to the hospital to be evaluated. As a reporter, you felt compelled to cover this story, so told the conference organizers you felt ill and got on the bus. Upon arriving at the Emergency Department, you realize that you need to talk to somebody in charge. At some point early in the drill, bust through the decontamination area and enter the treatment area. Touch as much as possible and approach a treating physician…remember, you need to get this story RIGHT NOW to let “the American public” know what is going on! Once you have been escorted by security out of the treatment area, please calm down and comply with physician requests. At first, you don’t feel as though your vital signs need to be taken…you’re trying to cover a story. Later, once you’ve calmed down, if asked about vital signs, please show the opposite side of this card. 1g You are a delegate to the Republican National Convention from Ohio. You had planned on arriving earlier, but your car broke down and you arrived at the convention this morning. You feel fine, but at lunch, you hear that several other delegates are complaining of weakness and nausea. When you hear that conference organizers are going to send a busload of people feeling ill to a local hospital, you begin to worry, so decided to go, even though you are asymptomatic. Basically, you are fine but are worried you may be sick like everyone else and just don’t know it yet. You are not belligerent, but feel you need to be checked out. If asked about vital signs, please show the opposite side of this card. 1G

9. General impression: No apparent distress, but the patient is insistent about covering the story. Vital Signs: Pulse: 90 Respirations: 18 BP: 124/86 Temp: 98ºF, PO Pupils: Normal General impression: No apparent distress, but the patient is concerned they may get sick like the other patients. Vital Signs: Pulse: 90 Respirations: 18 BP: 124/86 Temp: 98ºF, PO Pupils: Normal