Online CBRNe workshop tabletop session scenarios
Author: Hassan Farhat; e-mail: Hfarhat1@hamad.qa
Last updated
Author: Hassan Farhat; e-mail: Hfarhat1@hamad.qa
Last updated
Reviewed by: Dr. James Laughton; Prof. Guillaume Alinier
On February 7, 2021, was a beautiful evening with a full moon in Hazchem Ville. Everyone was looking forward to attending the concert by the worldwide famous singer Chemistra Nuclori that should start at 7 pm. Local newspapers have been speaking about it for weeks. They expected 20000 fans at least to be present in HazChem theatre for this concert, and crowding started in the theater’s gates two hours before the concert. With the worldwide terrorist threat, police and checkpoints were everywhere at the entry points of Hazchem Ville.
Ahmed and Victor are two doctors working in the academic hospital of HazChem Ville. Ahmed is an emergency doctor with 20 years of experience. In contrast, Victor is a newly recruited family physician with two years of experience in emergency medicine and is actively involved in improvement projects for patient safety and care. His latest project aimed to optimizing1 the inventory, procurement, and distribution of antibiotic medical countermeasures (MCMs) for post-exposure and prophylaxis from two of the most known bioterrorist diseases at HazChem Hospital. The intervention consisted of implementing an emergency stock for Anthrax infection, sufficient for 50 patients for three days in case of a sudden terrorist attack. A project that few of his colleagues appreciated since HazChem Ville is one of the safest cities in the world.
The hospital received two patients on February 14th, 2021, at 06.45 pm. They are both neighbours. They both fainted at their houses thirty minutes ago. They had a sudden onset of fever and severe headaches. They have no past medical history. After examination, Dr. Ahmed prescribed a flu treatment and was getting ready to discharge them. In between, the nurse Leshika informed him that she noticed the existence of a painless, raised, itchy, hard erythema with a black centre resembling an insect bite on both patients’ necks.
If you receive two patients with the same sudden onset of the symptoms above, would you do the same as Dr. Ahmed? Explain.
After examination, Dr. Ahmed decided to keep them for surveillance as they both were so weak to walk. 45 minutes later, 05 patients from the same neighbourhood came to the ED with the same fever symptoms and painless itchy erythema with a black center.
They were all in the same concert Dr. Ahmed decided that according to his long experience, this must be a dermal reaction due to an insect bite. Whereas Dr. Victor believes this might be a suspicious situation and exposure to a biological agent should be expected, precautionary measures should be taken.
2. Which one of them do you think is right? Explain.
3. What are the precautionary measures that Dr. Victor would be advising?
After further investigation of the patients, Dr. Victor figured out that one of those patients, called Mark, is working with a veterinary. He helped in carrying a package of dead animals labelled with United Nations (UN) number 2814, without even wearing basic PPE.
4. Using the ERG as indicated in the picture below, what new measures would you establish in this ED?
5. Based on the new information, Dr. Victor ordered for chest X-Ray for all those patients whereas Ahmed thinks this was only a waste of resources and time. What do you think? Explain.
The scenario above was inspired by: Peksa, G.D. et al. (2017) ‘A Calculation Tool and Process to Pre-Position Pharmaceuticals for Anthrax Post-Exposure Prophylaxis’, Health Security, 15(6), pp. 569–574. doi:10.1089/hs.2017.0032.
6. What would be the problem here? Explain.
a. Cumberland disease?
Yes ☐
No☐
b. Bacillus anthracis?
Yes ☐
No☐
c. Leishmaniasis?
Yes☐
No☐
d. Bioterrorist attack?
Yes☐
No☐
Overview:
This scenario is about an incident occurring in HazChem convention centre’s Metro station. It is composed of two parts:
The first part of the scenario is the phone call made by the security agent in HazChem convention centre’s Metro station to HazChem-Ambulance Service call taker in National Command Center (NCC) to report a suspicious incident during the crowded morning rush hour.
The second part is when the first ambulance reached the scene with two paramedics on board.
For this activity, kindly ensure to download the application of ERG 2020 available on android and IOS.
(1) (Call Taker): Ambulance Service, What’s the emergency address?
(2) (Caller): Hello Sir, I am the security officer in HazChem convention centre’s Metro station, near City Center mall basement B2, please send an ambulance fast, everybody is sick!!!
(3) (Call Taker) The address is clear; Ambulance is on the way, Sir. What’s the phone number you are calling from?
(4) (Caller) 30507396, 30507396, the mess is everywhere here, Sir!!!
(5) (Call Taker) Be reassured, sir ambulance is on the way. I will help you until the crew reaches you. Okay, tell me exactly what happened.
(6) (Caller) Everyone became suddenly sick. Sir, we are around 30 people here, almost all have the same problem, everyone is vomiting and coughing… Sir, my eyes are watery and burning…I don’t know what’s going on. I just came from the ground floor
(7) (Call Taker) if it is too dangerous to stay where you are and you think you can leave safely, get away and call us from somewhere safe. Don’t worry, Sir, an ambulance is on the way. I just need to ask you some answers so we can help the patients.
(8) (Caller) It’s chaotic! Everyone is using the stairs to leave the underground level.
(9) (Call Taker) Is everybody safe and out of danger?
(10) (Caller) I am not sure, I feel tightness in my chest now, and I am barely able to see… Am I going to die!!!! Please send us civil defence someone is saying that his friends are still down.
(11) (Call Taker) Help is on the way; ambulances also civil defence will handle the situation. Just stay out of danger and don’t allow anyone to go inside.
(12) (Caller) I will hang up the phone!
The line was disconnected.
A nearby ambulance with two paramedics on board, Ahmed and victor, was dispatched by National Command Center (NCC) to the scene. They arrived in 07 minutes. On their arrival, the situation was chaotic people were running out of the station; some were coughing, with watery eyes and runny noses, and sweating. One patient was lying on the floor with obvious tachypnea; two other persons had tonic-clonic movements. A security agent approached the two paramedics. “Sir! Sir! I am the one who called you!”” Coughing in between] “there are still many people inside lying on the floor. Please go and check them”. Ahmed and victor went straight back to their ambulance to wear an N95 mask.
According to the information provided, what seems probably to be the problem:
CO intoxication☐
Blister agent’s intoxication☐
Nerves agents☐
Chocking agent☐
Ahmed and victor went straight back to the ambulance to put on N95 masks. What do you think?
Please explain
I agree☐
I disagree☐. Explain.
3. What would be your report to NATIONAL COMMAND CENTER (NCC)?
4. What would you do if you were the one responding to this situation? Please Explain.
5. Besides Benzodiazepine®, what else do you recommend administering to the patient with convulsion?
Meanwhile, more people were still coming out from the stairs exit. The scene was still messy, and they were all coughing and holding their chest. Some were vomiting and all with red, watery eyes. More ambulances, police and civil defence unit arrived.
6. Using what we have seen in the presentation, draw the scene response layout on the whiteboard.
7. Assuming that this is a situation of a terrorist attack by “Sarin”, type the word “sarin” in the ERG phone app as indicated in the picture below and explain briefly what kind of information is provided about this agent.
On December 20, 2021, the Qatar Health conference was held in Hazchem Grand hotel in HAZCHEM Ville. Presenters and participants were invited from all over the world. On December 19, 30, the overseas speakers attended the dinner reception at 8pm. The Guests enjoyed the food except for Dr. Chaka, who was not feeling well and stayed in his room to rest. Dr Chaka, an epidemiologist, working with World Health Organization in Geneva, came straight from a two-week mission in his home country Democratic Republic of Congo.
03 hours after the welcoming dinner, the event coordinator called 999 to request an ambulance for Dr. Chaka as he was very sick.
(1) Call taker: Ambulance service, what’s the emergency address?
(2) Caller: Hazchem Grand hotel, floor 56, room 562.
(3) Call taker: okay, your address is clear, and an ambulance is on the way. What’s the phone number you are calling from?
(4) Caller: Actually, I am calling from the hotel landline, but I can give you my mobile phone number if it’s okay?
(5) Call taker: yes, please.
(6) Caller: it’s 30507060
(7) Call taker: 30507060. Okay, tell me exactly what happened.
(8) Caller: Dr. Chaka, a 45-year-old male, a guest in our conference, is very sick; he told me that he vomited around 04 times and he has diarrhoea, he is shivering. I am facing him now he is fully conscious.
(9) Call taker: Is he completely alert?
(10) Caller: yes
(11) Call taker: Is he breathing normally?
(12) Caller: he is breathing fast
(13) Call taker: is he bleeding or vomiting blood?
(14) Caller: he says his vomit is reddish blood-like, and his stool is watery and dark coloured.
(15) Call taker: Is the bleeding serious?
(16) Caller: no
(17) Call taker: Does he have a bleeding disorder or is he on blood thinners?
(18) Caller: he said no… is it something bad?!!! This kind of question scared me; I hoped the paramedics would be here soon…
An ambulance with two paramedics, Ahmed and Victor, was nearby responded and reached the scene within 5 minutes. At that time, Dr. Chaka was in the toilet, so they started collecting information from the event coordinator when they knew that the patient had arrived from the Democratic Republic of Congo the day before. He remained in his room since then as he was complaining of fever, acute bloody diarrhoea and epistaxis. Victor and Ahmed had a small discussion since the patient had a recent history of travel…
What do you think was the discussion about?
Meanwhile, the Hazchem Grand hotel chief personnel came to the paramedics and reported that around 30 guests were calling from the 49th and 50th-floor complaining of severe abdominal pain. Some of them were vomiting. They were all guests in the welcoming dining ceremony.
2 . What seems to be the problem? Explain.
3. What would Ahmed and Victor report to NATIONAL COMMAND CENTER (NCC)?
4. Should Ahmed and victor establish an IV line immediately and start administrating normal saline to Dr.
Coulibaly until they check the other patients? Explain.
5. In this situation, what should Ahmed and Victor do to manage the situation after the arrival of more ambulances?
6. Using what we have seen in the presentation, draw the scene response layout on the whiteboard.
7. Type the word “infectious substance” in the ERG phone app as indicated in the picture below and explain briefly what kind of information it provides you with.
HAZCHEM is a chemical industrial facility located in the Southern region of HAZCHEM Ville with a total land space exceeding 20,000 m2.
It is 06:30 p.m. on Friday, July 21st, 2021, and the National Command Center (NCC) of HAZCHEM Ville receives a call.
(1) Call taker: Ambulance service, what’s the emergency address?
(2) Caller: there is a yellowish smoke cloud coming out from one of the factory stores
(3) Call taker: what’s the address of the emergency, Sir, so we can send the ambulance?
(4) Caller: Hazchem factory in Hazchem Ville, near gate 5
(5) Call taker: okay, Sir, your address is clear, and an ambulance is on the way. What’s the phone number you are calling from?
(6) Caller: Sir, I don’t know if it is one of the factory landlines. Let me check my register and get back to you.
(7) Call taker: it’s okay, Sir, just give me a valid mobile number if we need to contact you later.
(8) Caller: 30506070, 30506070. This is my mobile number
(9) Call taker: okay, tell me exactly what happened.
(10) Caller: A very dense yellowish cloud of smoke was coming from one of the facility’s stores, and there were people doing the inventory. The alarm has been triggered
(11) Call taker: Are you with the patients now?
(12) Caller: no, I am outside the gate, but I think 10 people are working inside the store and 06 of my colleagues, each one is in an entrance gate
(13) Call taker: okay, Sir, as I told you ambulance is already on the way. Kindly stay online. I need to get more information from you.
(14) Call taker: is everyone safe and out of danger?
(15) Caller: I am not sure …as I told you, 10 workers are still inside the store with fumes, 60 in the building located downwind beside the store, now two security guards of the other facility gates are approaching my porta cabin, and they seem unharmed, we are safe for now, but the cloud can move due to the wind…exactly in the direction of HazChem football stadium.
(16) Call taker: What kinds of fumes or hazardous material are involved?
(17) Caller: Sir, I am just a security agent. I don’t know…
(18) Call taker: do you know the warning placard numbers?
(19) Caller: the store has a black and white lozenge with a skull picture inside the lozenge…
(22) Call taker: is anyone of your colleagues contaminated with chemicals?
(23) Caller: I am not sure about the workers inside the store, but two of my colleagues were exposed to the fumes.
(24) Call taker: are they completely alert?
(25) Caller: my colleagues are okay, but I am not sure about the others inside
(26) Call taker: do they have any difficulty breathing?
(27) Caller: I am not sure, Sir. They are both coughing non-stop, their eyes are tearing and reddening, and they are telling me that they have a chest-burning sensation, but as I previously told you, I have no idea about the others.
(28) Call taker: do they have difficulty speaking between breaths?
(29) Caller: no sir…
(30) Call taker: I already sent the ambulance to help you stay on the line I will tell you exactly what to do next. Do not open any doors or windows in an attempt to gain access to the patients.
(31) Caller: OK, Sir… the ambulance is here.
NCC supervisor noticed that they were receiving numerous calls from the HazChem compound situated 3 km downwind from Hazchem industrial facility with complaints of eye, nose, and throat irritation.
According to the information provided in the call taking, what could be the case? Explain.
Chemical Spill ☐
Fire ☐
Both ☐
2. Using the description provided in statement 19, use the ERG mobile app to determine the initial isolation distance.
An ambulance with two paramedics, Ahmed and Victor, reach the scene at 06:45 pm. Using a binocular, they also noticed the existence of another placard with the UN number on it, 1017.
3. What would Ahmed and Victor report to NATIONAL COMMAND CENTER (NCC)?
4. Using the ERG mobile app as indicated below, determine what is the name of this hazardous material, then identify the immediate isolation distance.
5. Using what we have seen in the presentation, draw the scene response layout on the whiteboard.
HazChem stadium was located 3 Km downwind, and the fumes cloud was moving along the wind direction. Hazchem stadium, with its closing roof, was hosting the semi-final between Chemstar and Biostar teams with full spectator attendance (around 40000). The football match was 93 minutes with a 2-0 score for Biostar team. Only 2 more minutes were approximately remaining in the game.
6. What would be the next action that you recommend?
