[Title]

1. [Title] [Date of Exercise]

2. Exercise Type • Tabletop exercise (TTX) • Discussion based • Exercise play is not a “simulation” • Players will discuss their agencies potential response to the scenario • Not all issues need to be resolved • Discussions will inform planning revisions and future exercises

3. Participants • [List Participants]

4. Agenda • Introductions • Goals and Objectives • Rules for Play • Assumptions and Artificialities • Exercise Format • Exercise [insert breaks where appropriate] • Part 1 • Part 2 • Part 3 • Part 4 • Recovery Discussion • Debrief/Hotwash

5. Goal • To increase preparedness for response to pandemic influenza and other public health emergencies

6. Objectives • [Choose objectives from Objective Worksheet]

7. Assumptions • Participants are aware of their internal response plans/procedures and are able to accurately represent them here • Evaluation is systemic not individual • Decisions made during the exercise are not necessarily precedent setting • The scenario is plausible

8. Artificialities • Narrow scope of the exercise • Many unknowns about how an actual flu pandemic will present itself • Artificial timeline • Incomplete process for decision making

9. Exercise Format [suggested] • Information is provided • Scenario Details • For more detail ask the facilitator • Targeted Questions • 10-15 Minutes to discuss amongst yourselves • Feel free to move around the room and engage others • 10-15 Minutes to discuss as a large group • Debrief at the end of the exercise

10. Safety • [Identify emergency exits] • [identify restrooms] • Real world events will be identified by the phrase “Real World” • Exercise may be terminated for real world emergencies

11. Questions? • Please set phones, pagers, etc to vibrate

12. Part 1

13. Major Events 1 • It is January. There have been reports of a severe influenza-like illness that has caused a number of deaths in several countries in Asia. There have also been suspected cases of human-to-human transmission. The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have sent teams to investigate. The national and international press is giving the story wide coverage.

14. Local Events 1 • [Insert from Local Events 1 column for the objectives chosen in the Objective Worksheet]

15. Questions • [Insert from Questions 1 column for the objectives chosen in the Objective Worksheet]

16. Part 2

17. Major Events 2 • It is mid-February. WHO has analyzed the virus and determined that it is a new strain of Influenza. Some clusters of human-to-human transmission have been confirmed in Asia. There is a confirmed cluster of cases in [Choose a domestic location that is far your jurisdiction], and suspected clusters are now being reported in 15 other states. [If not testing antiviral/vaccine distribution, consider adding “Antivirals do not appear to be effective and vaccine is not yet available”]

18. Local Events 2 • [Insert from Local Events 2 column for the objectives chosen in the Objective Worksheet]

19. Questions 2 • [Insert from Questions 2 column for the objectives chosen in the Objective Worksheet]

20. Part 3

21. Major Events 3 • It is late March. There are now many suspected cases of this flu in [your state or jurisdiction]. Nationally there are several areas of widespread activity and there have been cases reported in all 50 states. The case fatality ratio is estimated nationally at 2.0% (very serious illness). Some affected areas have closed schools and cancelled community events. [If not testing antiviral/vaccine distribution, consider adding “Antivirals do not appear to be effective and vaccine is not yet available”]

22. Local Events 3 • [Insert from Local Events 3 column for the objectives chosen in the Objective Worksheet]

23. Questions 3 • [Insert from Questions 3 column for the objectives chosen in the Objective Worksheet]

24. Part 4

25. Major Events 4 • It is early April. The CDC has declared this to be a Category 5 pandemic. The flu is widespread nationally and in [your jurisdiction]. Many local businesses are reporting up to 40% absenteeism, with some shutting down completely. It is estimated that 20% of the local population has become ill. There is no vaccine or antivirals available. Federal assets are dispersed and not available.

26. Local Events 4 • [Insert from Local Events 4 column for the objectives chosen in the Objective Worksheet]

27. Questions 4 • [Insert from Questions 4 column for the objectives chosen in the Objective Worksheet]

28. Recovery Discussion Two waves of illness have passed. The first was by far the most severe. It is expected that there will be an additional wave of illness that will be less severe than the first and the second waves, and will be comparable to a typical flu season. • What resources have been mobilized? • How will they be de-mobilized? • How will government services that have been temporarily suspended be reinstated? • What non-essential services need to be reinstated first? • How will costs be recovered? • What are the long-term/ongoing issues? • Mental Health • Repealing community containment measures (i.e. school closures) • Economic recovery • Etc • What strategies could your jurisdiction consider to initiate economic recovery? • Which local agencies should take the lead on these recovery issues? How could the private sector contribute to the recovery process? [This is an optional slide to facilitate a discussion on recovery issues and returning to “normal”. Questions should be focused on this process after the pandemic has ended.]

29. Debrief/Hotwash

30. Thank You! Acknowledgements: This table-top exercise was created using NACCHO’s Pandemic Influenza Tabletop Exercise Template (2007)