1. Bioterrorism Drill Case 4 Plague: Patient Roles

2. You work in an office in the suburbs and have been feeling increasingly lethargic and ill for the last few days with a cough and slight nausea, vomiting, diarrhea. It seems as though your spouse gave you this ‘bug,’ as they started with similar symptoms a day or two before you. Early this morning, your spouse began coughing up blood, so you took them to the Emergency Department. While waiting for your spouse to be seen, you also begin to cough up a bit of blood. You present to the ED with: Cough Thin, watery blood tinged sputum Weakness Nausea / Vomiting / Diarrhea Abdominal cramps If asked about vital signs, please show the opposite side of this card. 4Y You work in an office in the suburbs and have been feeling increasingly lethargic and ill for the last few days with a cough and slight nausea, vomiting, diarrhea. It seems as though your spouse gave you this ‘bug,’ as they started with similar symptoms a day or two before you. Early this morning, your spouse began coughing up blood, so you took them to the Emergency Department. While waiting for your spouse to be seen, you also begin to cough up a bit of blood. You present to the ED with: Cough Thin, watery blood tinged sputum Weakness Nausea / Vomiting / Diarrhea Abdominal cramps If asked about vital signs, please show the opposite side of this card. 4Y

3. General impression: Patient is in slight respiratory distress with watery, blood tinged sputum. The patient also has nausea / vomiting / diarrhea / abdominal cramping. Vital Signs: Pulse: 100 Respirations: 32 BP: 116/74 Temp: 99ºF, PO Pupils: PERRL General impression: Patient is in slight respiratory distress with watery, blood tinged sputum. The patient also has nausea / vomiting / diarrhea / abdominal cramping. Vital Signs: Pulse: 100 Respirations: 32 BP: 116/74 Temp: 99ºF, PO Pupils: PERRL

4. You work in a downtown office building and have been feeling ill for the last few days with a cough. At first, you though it was the flu, but it has gotten significantly worse since yesterday. Last night, you were kept up by repeated fits of coughing, and early this morning you noticed that you were coughing up blood. There are also some patches of black skin on some of your fingers and toes. Your primary care physician’s office is not open this early, so you decided to go to the local Emergency Department to be checked out. Your spouse, who works in the suburbs, has also begun coughing and feeling ill, but they haven’t mentioned coughing up any blood. You present to the ED with: Shortness of breath with a cough Thick, bloody sputum Weakness Nausea / Vomiting / Diarrhea Abdominal cramps Multiple bilateral necrotic fingers and toes If asked about vital signs, please show the opposite side of this card. 4R You work in a downtown office building and have been feeling ill for the last few days with a cough. At first, you though it was the flu, but it has gotten significantly worse since yesterday. Last night, you were kept up by repeated fits of coughing, and early this morning you noticed that you were coughing up blood. There are also some patches of black skin on some of your fingers and toes. Your primary care physician’s office is not open this early, so you decided to go to the local Emergency Department to be checked out. Your spouse, who works in the suburbs, has also begun coughing and feeling ill, but they haven’t mentioned coughing up any blood. You present to the ED with: Shortness of breath with a cough Thick, bloody sputum Weakness Nausea / Vomiting / Diarrhea Abdominal cramps Multiple bilateral necrotic fingers and toes If asked about vital signs, please show the opposite side of this card. 4R

5. General impression: Patient is cyanotic and in respiratory distress with thick mucopurulent hemoptysis. The patient also has nausea / vomiting / diarrhea / abdominal cramping, and has multiple necrotic lesions on their fingers and toes. Vital Signs: Pulse: 100 Respirations: 40 BP: 100/60 Temp: 101ºF, PO Pupils: PERRL, sluggish General impression: Patient is cyanotic and in respiratory distress with thick mucopurulent hemoptysis. The patient also has nausea / vomiting / diarrhea / abdominal cramping, and has multiple necrotic lesions on their fingers and toes. Vital Signs: Pulse: 100 Respirations: 40 BP: 100/60 Temp: 101ºF, PO Pupils: PERRL, sluggish

6. You work as a security guard at Union Station and have been feeling increasingly ill for the last few days with a cough, nausea, vomiting, diarrhea, and abdominal pain. Yesterday, you noticed that there was some blood in what you coughed up. This morning, you awoke with severe shortness of breath and were coughing up a lot of thick bloody sputum. Worried, you went to the Emergency Department to be checked out. You present to the ED with: Shortness of breath with a cough and thick, bloody sputum Weakness Nausea / Vomiting Abdominal cramps Severe, bloody diarrhea Multiple bilateral necrotic fingers and toes Inability to urinate While being decontaminated or triaged, please be towards the back of the group. After 2 or 3 minutes, you collapse and will remain unresponsive for the rest of the drill. If asked about vital signs, please show the opposite side of this card. 4B You work as a custodian at Union Station and have been feeling increasingly ill for the last few days with a cough, nausea, vomiting, diarrhea, and abdominal pain. Yesterday, you noticed that there was some blood in what you coughed up. This morning, you awoke with severe shortness of breath and were coughing up a lot of thick bloody sputum. Worried, you went to the Emergency Department to be checked out. You present to the ED with: Shortness of breath with a cough and thick, bloody sputum Weakness Nausea / Vomiting Abdominal cramps Severe, bloody diarrhea Multiple bilateral necrotic fingers and toes Inability to urinate While being decontaminated or triaged, please be towards the back of the group. After 2 or 3 minutes, you collapse and will remain unresponsive for the rest of the drill. If asked about vital signs, please show the opposite side of this card. 4B

7. General impression: Patient is unresponsive, cyanotic, incontinent of bloody stool and has multiple necrotic fingers and toes. Vital Signs: Pulse: 10 Respirations: 0 BP: 40/P Temp: 101ºF, PO Pupils: Pin point General impression: Patient is unresponsive, cyanotic, incontinent of bloody stool and has multiple necrotic fingers and toes. Vital Signs: Pulse: 10 Respirations: 0 BP: 40/P Temp: 101ºF, PO Pupils: Pin point

8. You are a college student who has a midterm at 8:30 this morning. Last night, you were “tricked into going out by your roommate” and ended up getting significantly inebriated. To be excused from your exam, you need a note from a doctor saying you were ill. If you waited until the student health center opened, you’d already be late if the doctor refused to write you a note, so you figured you’d better try getting a note from the Emergency Department. After telling the triage nurse you felt ill, you sat down to wait to see the physician. Then a bunch of people came in, and it started getting crazy, so, since all you need is a note from the doctor, you decided to go around through another door and ask the doctor to write you a quick note and you’ll be out of there. You present to the ED with: A killer hangover Fear you’ll be expelled from college for failing your midterm If asked about vital signs, please show the opposite side of this card. 4g You were watching the Learning Channel last night and saw a program about brain tumors. One of the symptoms mentioned in the program was a dull headache, and you have had a headache on and off for the last 2 days. Although your symptoms are relieved by acetaminophen, you are worried that you may have a brain tumor so came to the Emergency Department this morning seeking a “dog scan” like was discussed on the Learning Channel. You present to the ED with: Mild, Intermittent Headache, x2 days Anxiety over having a brain tumor If asked about vital signs, please show the opposite side of this card. 4G

9. General impression: No apparent distress, but extremely worried. Vital Signs: Pulse: 90 Respirations: 20 BP: 142/86 Temp: 99ºF, PO Pupils: PERRL General impression: No apparent distress but worried. Vital Signs: Pulse: 80 Respirations: 16 BP: 142/92 Temp: 99ºF, PO Pupils: PERRL