Bioterrorist Attack on Food: A Tabletop Exercise

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Responding to an OutbreakA Group Exercise on
Crisis and Risk Communication Skills
Based on the work of Carl Osaki, MSPH,
RS Department of Environmental Health Northwest
Center for Public Health Practice University of
Washington, Seattle
Version 2 February 2006
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Developed by

• Connecticut Partnership for Public Health
  Workforce Development
• Yale University School of Public Health
• Adapted for distribution by
• Yale Center for Public Health Preparedness

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Funded by

• Connecticut Department of Public Health
• Centers for Disease Control and Prevention Public
  Health Preparedness and Response for Bioterrorism
  Cooperative Agreement
• Centers for Disease Control and Prevention Center
  for Public Health Preparedness Cooperative
  Agreement
• New England Alliance for Public Health Workforce
  Development Health Resources and Services
  Administration Grant No. D20HP00003

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Sources

• This group exercise is based on materials from
  Hands on Training for Public Health Emergencies
  a tabletop exercise from the Northwest Center for
  Public Health Practice, SPHCM, University of
  Washington in collaboration with the Washington
  State Department of Health

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Purpose

• This learning activity is an opportunity for you
  to apply knowledge and techniques you learned
  about today in crisis and emergency risk
  communication in a simulated local public health
  emergency.

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Objectives of the Exercise

• Demonstrate use of bridging and risk
  communication principles
• Develop answers to top questions posed by the
  public
• Demonstrate empathy and caring
• Identify and discuss communication challenges
  that might arise during a local public health
  emergency

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Setting the Scene

• Respond in the scenario as you would, or think
  you would, if you were actually working for the
  local health department in the story.
• The scenario focuses on responding to public
  inquiries over the phone.
• The goal is to demonstrate use of communication
  principles and techniques.

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Description of Exercise

• Presentation depicting a fictional account of a
  public health outbreak.
• Storyboards
• Background information to put the scenario into
  context. Facts (information) known to all. Assume
  these facts have been verified.
• Three group activities and class discussions

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Instructions to Remember

• Respond as a group as the information emerges
• Focus on communication issues rather than
  specific procedures
• Take notes for class discussion

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Storyboard 1 The Setting
DogwoodCounty
HickoryCounty
PecanCounty
ElderCounty
MapleCounty
AshCounty
OakCounty
CedarCounty
PineCounty
FirCounty
ElmCounty
WalnutCounty
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Storyboard 1 The Setting

• Cedar County
• 150,000 residents
• 1 major city of 40,000
• 1 hospital
• 1 public water supply
• County health department staff with 30 employees
• Site of upcoming major economic trade group
  conference

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Day 1 Friday Late Afternoon
Update

• Gastrointestinal illness strikes
• Presenting via nurse hotlines, private providers,
  urgent care centers and hospital ERs
• Presenting patients tend to be middle-aged
  adults, with about 10 over age 65
• People are being seen in hospital ERs by late
  Friday

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Day 1 Friday Evening
Update

• High rate of people with common symptoms
• Stool samples taken on six of the cases
• Three people hospitalized for dehydration or
  other GI complications

• Severe diarrhea
• Fever
• Chills
• Headache
• Vomiting
• Abdominal pain
• Bloody stools
• Nausea

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Day 2 Saturday Morning
Update

• Patients still being seen in the ERs and urgent
  care centers
• At 10 AM, the number of patients exhibiting
  symptoms at the hospital ER is up to 15
• The hospital decides to notify the Cedar County
  Health Department
• The hospital expresses concern regarding its
  capacity to handle the numbers of patients
  needing treatment

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Day 2 Saturday Noon
Update

• The Cedar County Health Director calls in senior
  staff.
• The known patient count is 20 and growing.
• Local pharmacist calls the health department and
  asks what is happening. Her store is almost out
  of anti-diarrheal medicine due to heavy demand.

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Day 2 Saturday Early Afternoon
Update

• The Health Director convenes a meeting with
  senior staff around next steps.
• The Health Department decides to begin
  interviewing cases.
• The health department meets with the hospital and
  other key players
• It is decided that questions from the general
  public on the illness will be referred to the
  health department.

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Day 2 Saturday Mid-Afternoon

• Phone calls begin to trickle in to the health
  department from a worried public.
• The health director assigns a group of staff
  members to respond to public inquiries over the
  phone.

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Group Activity 1

• As a group, determine three key messages, based
  only on what is currently known about the event.
• Use Worksheet 1 to record your messages.

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Class Discussion

• Report out on your key messages, and how you
  determined them.
• As a class, review all messages from the groups
  and select three key messages for the health
  department staff to use.

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Day 2 Saturday Mid-Afternoon

• The health director approves the key messages
• Next, the staff are asked script answers to the
  questions that the public are likely to ask.

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Questions from the Public

• Are my family and I safe?
• What have you found that will affect my family
  and me?
• What can I do to protect my family and me?
• Who (what) caused this problem?
• Can you fix it?

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Group Activity 2

• Using the Summary Handout and Worksheet 2, script
  answers to questions from the public.
• Demonstrate use of the following
• At least one of the Recommendations for Risk
  Communication in an Emergency or the IDK
  Template
• Bridging to back to the key messages
• Expression of empathy and caring

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Class Discussion

• Report out on your responses to the public. What
  recommendations and/or template did you select
  and why?
• Items for class discussion
• How did each group use bridging and other
  templates and risk communication techniques to
  deliver key messages?
• What types communication of challenges are faced
  by the local health department at this point in
  the scenario?

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Day 3 Sunday Morning
Update

• Patient count up is to 30, following a news
  report on the suspected disease outbreak.
• The source is not yet determined, but food is
  highly suspected with attention focusing on fresh
  herbs.
• Most cases are middle-aged adults. The age range
  of cases is from 5 to 82 years.

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Day 3 Sunday Late Evening
Update

• Early results of stool sample tests indicate that
  Shigella sonnei is the common causative agent in
  the majority of the cases.

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Shigellosis Fact Sheet
Update

• Typical symptoms of Shigellosis include severe
  diarrhea often accompanied by fever, chills,
  headache, nausea, vomiting, abdominal pain, and
  possibly bloody stools.
• Incubation period is 1 to 7 days (usually 1 to 3
  days).
• Fewer than 10 of cases seek medical care and
  fewer have confirmatory stool cultures performed.
  
• Complications such as dehydration may result in
  hospitalization but deaths are rare.

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Day 4 Monday Morning
Update

• When Health Department staff return to work
  Monday morning, the phone lines are jammed with
  concerned callers.
• There have been no new cases of illness reported
  to the health department since Sunday AM.
• The source of the outbreak has not been
  identified and remains under investigation.

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Group Activity 3

• Based on the new information from Day 3
• Review the key messages and decide if any should
  be updated or changed.
• Review your responses to top questions from the
  public and update with the new information and
  key messages.
• Use A-SHIG Fact Sheet and record your answers on
  Worksheet 3.

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Class Discussion

• Report on your updated messages and responses.
• Class discussion
• Using the Crisis and Emergency Communication
  Card, evaluate the responses from the groups.