BIOLOGICAL ATTACK FOOD CONTAMINATION Table Top Exercise BIOLOGICAL ATTACK FOOD CONTAMINATION

Tabletop Exercise Introduction Introduction of players How the exercise will be played Questions and answers

Narrative The Universal Adversary terrorist group has delivered liquid Clostridium botulinum to pre-selected terrorist plant workers. Two batches of prepared luncheon meats & three batches of orange juice are contaminated with C. botulinum, with distribution to the West Coast, a southwestern state, and in the Northeast. Over the last three days, adults, children and the elderly became seriously ill with botulism. Hospitals in these cities are overwhelmed with the large number of cases requiring critical care. Your facility is located in one of the impacted areas.

Scenario Event 1 08:30 – Two patients were admitted earlier in the day exhibiting signs of facial paralysis and difficulty in breathing, and were diagnosed with C. Botulinum. Since that time, State authorities have informed the facility of the attack and possible impact on the locality. Expectations are of a large number of victims.

Scenario Event 2 10:00 – Patients begin arriving, many of whom self present. The ED is stressed but functioning. The media is arriving and are locating themselves at different areas on the hospital grounds.

Scenario Event 3 10:15 – Official information from agencies regarding the attack and the impact are sketchy. Rumors are circulating about the effects of the attack on other areas of the country. Some members of the media are attempting to gain entry to the facility through the ambulance bay.

Scenario Event 4 10:30 – As patients arrive, the ED notices a larger than expected number of adolescent victims. The total number of victims presenting at your facility appear to be exceeding expectations.

Scenario Event 5 11:30 – Medications, especially antitoxin, needed for treatment are beginning to dwindle.

Scenario Event 6 13:30 – Members of the local police department, as well as representatives from the FBI and State Police arrive as part of their investigation.

Please return promptly Break 10 minutes Please return promptly

Scenario Event 7 21:30 – Used disposable supplies and equipment are being left exposed at various areas. The number of actual cases of C. Botulinum appears to have subsided, however there is an increase of worried-well presenting themselves to the ED.

Scenario Event 8 04:30 – The attending staff is beginning to show signs of stress. A few incidents of minor altercations within the medical staff have been reported. One nurse has passed out, breaking a number of vials of antitoxin in her fall.

Scenario Event 9 08:30 – There have been no new cases in the last 2 ½ hours. The patients admitted are stabilized and resting and the patient surge has ended.

Hot wash Player’s feedback Evaluator feedback Group discussion Suggestions for improvement