[Date]

1. [Date]

2. Jurisdiction specific opening montage

3. WELCOME AND OPENING COMMENTS [Jurisdiction Lead Planner]

4. BIOLOGICAL WEAPONS OVERVIEW

5. DEFINITION 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

6. 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

7. 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 biological attacks 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

8. ANTHRAX CASES Fall 2001 23 total anthrax infections • 5 deaths from inhalation infections • 11 cases inhalation infections • 12 cases cutaneous anthrax 2001 Sept. 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 DC Oct. 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.

9. 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)

10. EXERCISE OVERVIEW

11. PURPOSE To provide participants with an opportunity to exercise current concepts, plans, and capabilities for response to a public health emergency resulting from a biological terrorism incident

12. SCOPE Epidemiological Investigation Surveillance DOMESTIC INCIDENT MANAGEMENT OF BIOLOGICAL TERRORISM Resources & Capabilities Diagnosis

13. DESIGN OBJECTIVES Insert Jurisdiction specific objectives

14. EXERCISE STRUCTURE Module 1 – Module 2 – Module 3 –

15. Situation Update HOW MODULES ARE CONDUCTED [Situation Manual Cover Page] +

16. SITUATION MANUAL Introduction Modules Questions Appendices After-Action Report Evaluation Forms [Situation Manual Cover Page]

17. Situation Update Facilitated Discussion Caucus Period HOW MODULES ARE CONDUCTED [Situation Manual Cover Page] + Spokesperson designated to present summary

18. FUNCTIONAL RESPONSE GROUPS Public Health Emergency Management Hospital Incident Command Infection Control/Healthcare Providers Public Safety Public Information

19. ROLES & RESPONSIBILITIES Facilitators Players Observers Organized by functional area Talk between the tables is encouraged Moderate the flow of discussion Local community policy experts Can move between tables Can be used as a resource by Players Not a functional or command post exercise, but a facilitated discussion

20. 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

21. EXERCISE RULES There Is No School Solution Agree to Disagree Don’t Limit Yourself Decisions Don’t Set Precedents Acronym-Free Environment No-Fault, Low-Threat Environment

22. ADMINISTRIVIA Phones, pagers, radios Bathrooms Lunch Breaks Badges Evaluation Forms Additional Resources

23. 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 Comments Hotwash with planning committee immediately following exercise

24. BEGIN EXERCISE

26. MODULE 1INCUBATION

27. Month Year GENERAL INFORMATION 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

28. Day Date Time CASE STUDY #1 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

29. Day Date Time ILLNESSES INCREASE 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

30. Day Date Time CASE STUDY #2 • 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

31. Day Date Time STUDENT TRANSPORTED • 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)

32. Day Date Time CASE STUDY #3 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

33. Day Date Time MEDIA TAKES NOTICE 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

34. Day Month Time PATIENT DETERIORATES 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

35. Day Date Time PATIENT’S ACTIVITIES 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

36. Day Date Time CONTACTS MADE 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

37. CASE STUDY UPDATE Day Date Time 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

38. Day Date time CONCERNS INCREASE 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

39. Day Date Time MEDICAL INTELLIGENCE [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

40. Day Date Time HEALTHCARE EMERGENCY [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

41. Day Date Time CASE 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

42. Day Date Time Deadly Bug NEW “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

43. Day Date Time CONCERN ESCALATES 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]

44. Day Date Time RESOURCES STRETCHED 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

45. CASUALTY SUMMARY* Total Presenting: [#] Currently Hospitalized [#] Deceased [#] Examined and Released/Monitored [#] * Report as of Day, Date, Time

46. 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

47. CAUCUS PERIOD

48. FACILITATED DISCUSSION

49. MODULE 2INITIAL RESPONSE

50. Day Date Time MEDIA FRENZY 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