Miscellaneous Injects
Introduction: In order to increase the flexibility and the uniqueness of your exercise, the designers have created a series of additional “injects”
that allow the facilitator and/or the controller to customize the product to match the needs and enhance the experience for the players. These
additional “injects” may be added to the exercise at whatever point the facilitator/controller may deem it fitting. In addition, the jurisdiction’s
design team is encouraged to use these examples as inspiration to create its own “injects” based upon the specific qualities of the jurisdiction.
Economic Injects
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Due to lay-offs, insufficient staffing has enabled the ambushing of remaining prison guards
a.
11 prisoners escape and are loose in your jurisdiction
b. One guard is seriously injured and is on her way to the hospital
To minimize costs, all public primary and secondary schools are on a 4-day week schedule
Local unemployment is up to 16%
Local soup kitchens are overwhelmed
Children Protection Services note an increase of child abuse cases in your jurisdiction
a.
Blame it on new stressors such as no job, no food, no money
Garbage pick-up is now only twice weekly
There will be no funds for vector/insect control this year
Infectious Disease Injects
1)
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7)
A major pertussis outbreak is occurring on the West Coast
a.
46 cases (23: CA, 16: WA, 7: OR
b. 4 deaths
c.
Blamed on vaccination fears
d. Blamed on religious beliefs
Local public health receives call from local ER, clinic, and/or urgent care center about a possible case of whooping cough
Mumps epidemic in the Northeast
a.
CDC: 367 lab-proven cases
b. No deaths
c.
23 hospitalizations
Local public health receives call from local ER, clinic, and/or urgent care center about a possible case(s) of mumps
CDC dispatches an alert about a possible food-related illness centered in a state contiguous to your jurisdiction
a.
Manifestations (majority of the 36 suspect cases): Fever, chills, N, V, diarrhea
b. 1 hospitalization: Hemolytic Uremic Syndrome
c.
E. coli?
Receive a local ER call from ER physician who suspects cases of food-borne botulism cases in his ER currently
a.
Number: Immigrant family of 5 (Mom, Pop, Kids aged 3, 13, and 15)
b. Manifestations: Abdominal pain, Nausea, vomiting, ptosis, slurred speech, dyspnea, generalized weakness.
c.
One required invasive airway control (RSI) and a ventilator
d. Wants antitoxin now.
Local media hears about cases of botulism and questions if this was a bioterrorist incident.
Natural Catastrophe Injects
Hurricanes Injects
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6)
Hurricane season officially begins
Hurricane season officially ends
Series of tropical depressions beginning off African coast
Tropical storm Ada set to hit US Virgin islands in 2 days
Ada picks up strength
a.
Category 1 to hit US Virgin Islands tonight
i. Preparedness and evacuation actions: center stage
Category 1 Ada hits St. Thomas
a.
Minimal damage reported
7)
Ada becomes Category 3
a.
Dead aim on Bermuda
8) Bermuda crushed by Ada
a.
Category 4
b. 25 dead
c.
125 injured
d. 567 homeless
9) Ada scheduled to strike Carolinas in 2 days
a.
Now Category 3
b. Could reach Category 5 when fueled by warm waters off coastline
c.
Evacuation plans in effect for Georgia, and the Carolinas
10) Ada taking dead aim on Charleston, SC by tomorrow PM
a.
Category 5
11) Due to the imminent threat of a Category 5 hurricane scoring a direct hit on your jurisdiction, one of your hospitals will
evacuate.
a.
Urgent
b. Two-day window
Earthquake Injects
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4)
A severe earthquake has just hit your jurisdiction
a.
23 seconds duration
b. 2AM
The earthquake registered a 7.3 on the Richter Scale according to USGS
A local hospital reports that
a.
The HVAC is non-functional
b. The sprinkler system has turned on
c.
HICS is deciding whether or not to evacuate all its 325 patients now
Your jurisdiction’s FD is reporting multiple fires in the immediate vicinity of the EOC
Wildfire Injects
1)
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6)
Local Forest Ranger station is reporting brushfire about five miles away from a local hospital
The Haily Goliteley winds have changed direction and the wildfire is heading towards a local hospital.
Hospital decides to evacuate. Activates evacuation protocol.
The Haily Goliteley winds have changed direction and the wildfire is heading towards your Command Post.
The EMA director is trapped by the wildfire.
The PH commissioner has not been heard from since the wildfires raged out of control.
Tornado Injects
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Bad weather has been making pandemic decision-making difficult.
Rain has been an ongoing predicament.
Spotty flash floods have been making EMS traffic problematic.
Tornado Watch in effect until 2200.
Tornado Warning in effect until 2300.
News Break: Reports of a tornado strike near a trailer park recreation area.
Breaking News: Trailer park said to be decimated by presumed tornado.
Breaking News: EMS/Fire report trailer park destroyed by tornado.
Breaking News: 85 trailers located in trailer park. One found intact, SAR under way.
Terrorism Injects
1.
2.
Breaking News (American News Service): Car-bomb detonated outside Mall of the Americas
a.
At least 50 dead; 150 injured
Breaking News: Crew of suicide bombers attack Paris Metro
a.
Estimates: 370 dead; 1000 wounded
3.
Breaking News (ANS): Domestic militants raid police station in Dubuque, Iowa
a.
15 cops executed
4. MyTube video announces establishment of ties between Al Qaeda and AnarchusPrimum
5. Car-bombs blow up ERs in 5 cities
a.
Spokane
b. Tallahassee
c.
Richmond, VA
d. Suffern, NY
e.
El Paso
f.
Total: 28 dead, 65 wounded
g. AnarchusPrimum claims responsibility
6. FBI warns local law enforcement agencies of a potential threat by AnarchusPrimum
7. Three suicide bombers strike at Paddington Station in London
a.
250 dead at least
b. Hundreds more injured
c.
Al Qaeda claims responsibility
d. Warns more attacks on the way
8. Mining company in West Virginia admits that 1000 pounds of ANFO are missing, according to Cronkite News Net
9. A suspected cyber attack on your jurisdiction’s infrastructure has caused a blackout in your largest population center
10. Suicide bomber detonates self at the observation deck on the Empire State Building
a.
Dozens killed
b. NYC on high alert
H5N1 Pre-Pandemic and Pandemic Vaccine Injects
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Calls flood your agency demanding to know when and where the H5N1 vaccine will be
Local HCPs are calling to see whether Vitamin D and Gingko biloba will help because of their immune-boosting properties
Several local HCPs voice concern about possibility of Guillain-Barrè
Local media report on a G-B patient in ICU on a vent who received H5N1 vaccine 3 days earlier
State DOH wants location of all H5N1 vaccination PODs in the jurisdiction
State DOH advises the development of a drive-through POD for specific gentry encumbered by age, pregnancy, and children
CDC advises that Out Of Date (OOD) H5N1 vaccine may be administered first
Gentry begin questioning advisability, safety, and efficacy of OOD vaccine. “After all, they were wrong about the oil leak. Why not
the vaccine?”
On a long, long line at a H5N1 POD, an elderly male collapses and dies from an apparent cardiac arrest. ALS was unavailable at the
time. There’s intense media scrutiny.
Vaccination PODs have become a 7-7 operation. However, due to number of gentry outweighing the PODs, media editorials demand
24-7 operations.
Governor allows non-traditional HCPs to administer vaccine without liability fears (includes EMT-Ps)
Governor allows non-traditional HCP students to administer vaccine with supervision and 2-hour training
News headline: Asthmatic teenager dies after H5N1 vaccination
CDC announces that until amount of vaccine increases, vaccinations should be triaged to the young, immunosuppressed, and/or and
middle-aged. Those over 60 receive no vaccine until directed by CDC.
a.
Bariatric specialist questions whether bariatric/obese patients shouldn’t be priority since these types of patients were at
increased risk of death with H1N1.
PH receives reports that on the 1st day of PODs, people on lines were passing out due to environmental factors, dehydration, and
hunger
Phone call from jurisdiction’s top elected officials requesting very strongly that vaccination be given to all his staff regardless of
priority because the business of government must receive priority.
WHO announces that stockpiles of clade 1 and clade 2 H5N1 vaccines have been developed and have been stockpiled in many
countries. However, it is not certain whether there will be cross-reactivity between the presumed current H5N1 clade and the preexisting vaccines. Research is ongoing.
SAGE (Strategic Advisory Group of Experts) on Immunization is convening emergently at WHO headquarters to consult with the
Director-General.
a.
The group had no comment as they arrived in Geneva except to say that up until the present outbreak there had been ~500
human cases of H5N1in 15 countries with 289 deaths.
b. A couple of the attendees added that the present situation is disturbing especially since they lost their luggage.
An infectious disease specialist is calling your agency to see whether, besides the adjuvanted vaccine, there is or will be an
unadjuvated one for those who are worried about autistic progeny.
20. SkyHigh News reveals that two members of SAGE are on the board of the pharmaceutical companies that are making H1N1, H5N1,
and seasonal flu vaccines.
21. WHO announces that based on preliminary research, it is advisable to begin inoculating each nation’s citizens with the stockpiled
H1N1, H5N1, and seasonal flu viruses.
a.
Scientists around the world are evaluating whether these vaccines will prove to be immunogenic with regard to the present
H5N1 virus.
22. CDC announces to all USA PH agencies to begin distributing all their seasonal flu stockpiles to the communities and for the
communities to begin immunizations.
23. Calls are coming in to your jurisdiction by concerned citizens asking whether the vaccine is thimerosol-free.
24. Your agency is taking calls from immunization PODs concerning people on line who mention they had some sort of vague
neurological complaint like weakness within 6 weeks of getting a seasonal flu shot. Should they go ahead and give the H5N1 shot?
25. Several PCPs are calling your agency asking about data with regard to adding natural anti-oxidants (blueberries, tart cherry juice,
pomegranate juice, etc.) to their patients’ diets to help protect them against H5N1. They are particularly concerned about their
immunocompromised patients.
26. Various news media are reporting on the lack of forethought by many countries with regard to prepandemic H5N1 vaccine stockpiling
a.
Governmental spokesmen cite no money, bureaucracy, politics, safety, efficacy
27. Debtor nations are demanding that industrialized nations donate part of their prepandemic H5N1 caches.
28. Congress is demanding to know why there aren’t more doses of perpandemic H5N1 vaccine when the stockpile began years ago.
29. CDC announces that it will use its 15 million-dose prepandemic H5N1 cache to vaccinate infrastructure personnel
30. It has been discovered that poultry destined for the San Ramon Novarro relief effort did not receive the requisite H5N1 vaccine.
a.
An Interpol investigation is under way to determine criminality
b. It is hypothesized that these poultry were latently infected and then spread the disease to other fowl and humans.
31. A drug company in Hungary announces it has an effective single-dose vaccine
32. Germany, Indonesia, Switzerland, and Vietnam are using their prepandemic H5N1 caches to immunize their populations.
33. A new H5N1 recombinant vaccine virus has been developed by the WHO Collaborating Center for the Surveillance, Epidemiology
and Control of Influenza at the Centers for Disease Control and Prevention (WHO CC), Atlanta, USA from
34. Major grocery chains are reporting that their vegetable and fruits are mostly sold out after local experts extolled the immunologic
benefits of certain produce.
a.
It may take weeks for more produce to come into the jurisdiction.
b. “Your kumquat or your life.”
35. There has been a steadily increasing stream of patients coming to the EDs complaining about muscle soreness, malaise, headaches
within a day of getting their H5N1 vaccine.
a.
ED: “Can’t you guys do something to reassure them and tell them to stop!”
36. Your agency receives a call from a vaccination POD. A client says she wheezes after eating a plate of bacon and scrambled eggs.
Should she get the shot?
37. There is a report from the field about this client who had an immediate anaphylactic reaction two minutes after receiving the H5N1
shot.
a.
Media questions why there was no ALS cart nearby.
38. CDC announces that for the time being H5N1 vaccine should be administered separately from the H1N1/seasonal vaccines.
39. An OB MD calls up and wonders what, if H1N1 was so bad for pregnant patients, they should say to their pregnant patients for whom
the H5N1 vaccine in not currently recommended when the M&M of H5N1 is so much worse.
40. Within your agency, mid-level administrators are asking about a strategy to capture the inoculees for their second shot a month later.
41. AAP demands greater research into the use of H5N1 vaccine on the “ignored” pediatric population.
42. Call for a POD: Nursing Mom wants to know when to commence breast feeding after getting the H5N1 shot.