Situation Manual

Time Allotted / 415 Minutes
Gastro Gambit – Start Exercise
During the exercise it will be important to remember and comply with the following statements:
·  It is important NOT to jump ahead in the exercise scenario. In other words don’t focus on what might happen, focus on the Common Operating Picture that is presented during the exercise to make informed decisions.
·  In any exercise a number of assumptions and artificialities may be necessary to complete play in the time allotted. During this exercise, the following apply:
1.  The scenario is plausible, and events occur as they are presented.
2.  There is no “hidden agenda”, nor any trick questions.
·  Exercise Basics:
1.  This exercise contains a total of 24 scenario and inject pages.
2.  The exercise is self-paced and it should take approximately three hours to complete. However, based on the time spent on each scenario and inject the exercise may be completed in under three hours or it may take much longer than three hours to complete the exercise.
3.  There is a scheduled 15 minute break approximately half way through the exercise.
4.  All videos embedded within this exercise can be enlarged to FULL SCREEN by simply clicking on the full screen icon in the lower right hand corner of the video.
5.  Thoroughly review all scenario information and injects as they are presented during the exercise.
6.  Identify one individual to be responsible for controlling the computer and inputting responses to the exercise injects.
·  At the end of the exercise you will need to complete an evaluation (Hotwash) on how your team preformed during the exercise. The Hotwash will consist of your team providing comments on three areas in which it performed well (Thumbs Up) and three areas your team will need to improve upon (Thumbs Down) to enhance its preparedness, response and recovery capabilities. Found below are Hotwash examples:
Thumbs Up – During the exercise our team consulted our disaster plans and procedures and found them to be complete.
Thumbs Down – During the exercise our team consulted our disaster plans and procedures and found portions of the plans and procedures that need to be revised.
·  After the exercise each registered participant who took part in the exercise will receive an e-mail to log into the ONX System to complete their Individual Hotwash to access their Certificate of Participation.
·  If you need assistance anytime during the exercise please call the Help Desk at:
Phone Number – 605-475-4700
Account Number – 1076890 #
Time Allotted / 20 Minutes
Gastro Gambit – Scenario – # 001 / Image of Lincoln Elementary School
Day One / Saturday – May 14
Sara Johnson, a fifth grade teacher at Lincoln Elementary School, is hosting her annual End of School Awards Banquet for 29 students and their parents at Los Compadres Mexican Restaurant. As is Sara’s normal practice she pre-ordered chicken taco dinners for everyone. These meals featured chicken tacos, beans, rice, chips with salsa, and ice cream sundaes for dessert.
Day Three / Monday – May 16
Nine of Sara’s students have stayed home from school. They all are suffering from a fever and diarrhea, and three are also vomiting. Individually (and not knowing that the others were ill), parents have given their children fluids and hoped for improvement. In one household, both father and son are sick.
Time Allotted / 10 Minutes
Gastro Gambit – Scenario – # 002 / Image of Sick Student
Day Four / Tuesday – May 17
The nine students are still absent from Lincoln Elementary School and Sara mentions the absences to the school nurse, who decides to call their parents to check on the children. While talking with the parents the nurse mentions that there are several other students that are home sick.
Learning this information, some of the parents call each other and decide that their children should go to the doctor since they all experiencing similar symptoms.
As various physicians examine the sick children and speak with their parents, it is discovered that the nine students from Sara Johnson’s class are sick with similar symptoms.
These similarities lead the physicians to believe that the children contracted a viral or microbial communicable disease that could be transmitted person-to-person or via food or water. Along with treatment information being provided to patients, stool samples are collected for laboratory analysis.
Eight more students suffering from fevers and diarrhea have visited Lincoln Elementary School’s nurse. None of these students were from Sara Johnson’s class. The nurse decides to contact their parents and sends all eight students home from school.
Time Allotted / 10 Minutes
Gastro Gambit – Scenario – # 003 / Image of School Lunch Room
Day Five / Wednesday – May 18
The Lincoln Elementary School nurse is visited by 16 more students with gastro-intestinal (GI) illness who are not in Sara’s class.
The nurse is alarmed at the rate of absenteeism and illness at her school and decides to contact the school’s foodservice director to inform him about the preponderance of gastrointestinal illness among the students. The foodservice director decides to assess the school’s food safety records for anything that might have indicated a problem in the school cafeteria.
The nurse decides to contact nurses from other schools within the school district to see if they have observed a similar increase in absenteeism. The nurse makes the decision to contact the local health department due to the number of sick students.
Time Allotted / 10 Minutes
Gastro Gambit – Inject – # 004 / Image of Roles / Responsibilities
Does your health department have a role in responding to a food-related human health emergency? / Yes / No
If the above answer is yes. – Briefly describe that role.
Time Allotted / 15 Minutes
Gastro Gambit – Inject – # 005 / Image of Public Health Logo
It is 3:30PM on May 18 when the nurse from Lincoln Elementary School contacts your health department.
Knowing that there are only a few hours left in the day, describe in detail the IMMEDIATE ACTIONS that your health department will take.
(Note: Remember that there is only 90 minutes left in the workday.)
Time Allotted / 20 Minutes
Gastro Gambit – Inject – # 006 / Image of Money
With the reality of today’s limited budgets and human capital, describe how the decision is made to allocate resources to follow-up on an apparent case of foodborne illness.
Does your health department have a decision tree to follow when making such a decision? / Yes / No
If the above answer is yes. – Outline in detail the decision making process.
Time Allotted / 20 Minutes
Gastro Gambit – Scenario – # 007 / Image of Resources
Contained below are resources that could be useful to your health department as is responds to this health emergency.
Guidelines / Plans / Systems
Foodborne Disease Outbreak Response - Toolkit / HTML
Foodborne Outbreak Investigations / HTML
Guidelines for Foodborne Disease Outbreak Response / HTML
National Outbreak Reporting System - Guidelines / PDF
Procedures to Investigate Foodborne Illness / PDF
Time Allotted / 10 Minutes
Gastro Gambit – Scenario – # 008 / Image of Laboratory
Day Six / Thursday – May 19
Eastern Shore Labs LLC, a major private clinical laboratory, has begun analyzing 12 stool specimens: six from Sara Johnson’s class, five from some of the other ill students and one from a sick adult. Initial results are expected by Saturday or Sunday.
Time Allotted / 10 Minutes
Gastro Gambit – Scenario – # 009 / Image of EPI
As your health department talks with other schools in the district and the clinical professionals, the department identifies 11 possible suspect cases from other schools, including seven high school students and two adults from the same community as Lincoln Elementary School.
The management of your health department has decided to begin an environmental health / epidemiological investigation.
Time Allotted / 10 Minutes
Gastro Gambit – Inject – # 010 / Image of Activation
Briefly describe how the members of the Environmental Health / Epidemiological Team will be notified and the instructions they will be provided upon notification.
Time Allotted / 15 Minutes
Gastro Gambit – Inject – # 011 / Image of Responsibility
As your health department activates its Environmental Health / Epidemiological Team, will it utilize the Incident Command System (ICS)? / Yes / No
If the above answer is yes. – Identify the individual by name and title that will fill the leadership role for each of the ICS positions and describe in detail what the roles and responsibilities of that position.
(Note: In addition to the standard ICS positions list any positions specific to your health department’s plan.)
(Example: Position: Logistics – John Harper – Environmental Health Specialist / Responsibility: Maintaining the a current inventory of all consumable supplies and equipment used during the response as well as obtaining any consumable supplies and equipment that are needed to effectively manage the teams response.)
If the above answer is no. – Describe in detail the system that will be utilized to effectively manage the response.
Time Allotted / 30 Minutes
Gastro Gambit – Inject – # 012 / Image of Communications
Upon activation of the Environmental Health / Epidemiological (EH / EPI) Team, it will be important to for the team to remain in contact with appropriate regional and / or state health agencies.
Prepare a list of all the health agencies with which the team will need to stay in contact throughout this event.
(Note: The list should contain the name of the agency along with a primary phone number and e-mail address.)
Contact via phone one of the above agencies. Upon making contact provide them with a short briefing regarding this event.
Begin the conversation with “THIS IS AN EXERCISE” and end the conversation with “THIS IS AN EXERCISE”.
Were you able to establish contact with the agency that was called? / Yes / No
In addition to using the phone, describe any other methods of communications that will be utilized to maintain contact with regional and / or state health agencies.
Time Allotted / 20 Minutes
Gastro Gambit – Inject – # 013 / Image of IAP
Based on current information and the health department’s plan develop an Incident Action Plan (IAP) that focuses on INITIAL RESPONSE ACTIVITIES associated with effectively managing this incident.
In preparing the IAP list the actions to be taken, identify any resources that will be needed to undertake each listed action and prepare a timeline for completing each action.
(Example: Action – Assess staffing and supply needs to support operations. / Required Resources – Staffing Matrix & Inventory List. / Timeline – 2 Hours.)
Time Allotted / 25 Minutes
Gastro Gambit – Scenario – # 014 / Image of Media
Day Seven / Friday – May 20
Susan Wilson, a reporter from the News Herald, the regions daily newspaper, has gotten wind of the situation and has contacted the school system and your health department.
Prepare a strategy for working with the local media during this event.
Time Allotted / 20 Minutes
Gastro Gambit – Inject – # 015 / Image of Team
Members of your health department’s staff have gathered and are awaiting instructions to begin field operations.
Describe the make-up of the public health teams that will conduct onsite inspections and interviews.
Describe the system that will be utilized to dispatch teams to various locations and how team records will be processed and maintained upon teams returning to the health department.
Prepare a list of the resources that will be required to support field operations.
(Note: The list should include consumable supplies, equipment and forms.)
Time Allotted / 20 Minutes
Gastro Gambit – Inject – # 016 / Image of Interview
Due to the cluster of illnesses in Sara Johnson’s class your health department decides to conduct hypothesis-generating interviews with the sick students and their parents to try to determine the route of exposure.
Outline in detail how this will be accomplished.
Will the EH / EPI Team use a standard template questionnaire or will an event specific questionnaire be developed to conduct interviews? / Template Questionnaire / Event Specific Questionnaire
If the above answer is to develop an event specific questionnaire. – Briefly describe how the questionnaire will be developed and identify who will be responsible for its development.
Time Allotted / 15 Minutes
Gastro Gambit – Inject – # 017 / Image of Field Collections
Day Seven / Friday – May 20
Members of the EH / EPI Team have completed their interviews with the sick students and their parents.
Based on current information identify the locations that the EH / EPI Team members would turn their attention to next as they continue to gather information regarding multiple exposures that the ill people may have in common.
Time Allotted / 15 Minutes
Gastro Gambit – Inject – # 018 / Image of Database
As the investigation continues it will be important to establish and maintain an effective database regarding all the information that is being collected.
Describe how this will be accomplished.