Summary:
Teams of students participate in a 2 round simulation that begins with an outbreak of smallpox in Kansas City. Each student assumes a role –a news reporter, a doctor at a local hospital, a grocery store owner (civilian), an expert in disease, the governor and the President of the United States. Each faces a dilemma which does not have a clear, obvious answer. The students discuss and come to the best decision they can only to find another dilemma facing them again. The students again are challenged to make the best decision. All debrief about the process and the situational ethics evident in the simulation.
Learning Objectives:
Identify factors that may help prevent, control or cure the disease in the scenario.
Participate in a role play scenario that involves making decisions for others and exploring the steps and knowledge needed to make an ethical decision.
Recognize that some decisions can not be made only on a “medical” level but has pros and cons that will affect the patient and family in other ways.
Identify pros and cons of the hazards present and the danger and risk involved in each decision.
Identify ways to resolve the types of conflicts faced before the next time similar situations come up (suggest clinical trials or activities).
Materials and Supplies:
Student handout: 1 copy of roles and dilemmas from Outbreak Simulation handouts Facilitator’s handouts (Brief #1 and Brief #2) found in Outbreak Simulation handout
Large paper to chart decisions and evidence for each decision
Markers
Background Information and Resources:
Background information sheet: The Real Outbreak exercise: “Operation Dark Winter” includes link to materials about this exercise held in 2001.
Resources
Outbreak Simulation adapted from: http://www.upmc-biosecurity.org/website/events/2001_darkwinter/
More information about ethical decisions in biomedical fields: http://www.brown.edu/Departments/Center_for_Biomedical_Ethics/overview.html
Background information about smallpox: http://www.bt.cdc.gov/agent/smallpox/disease/
Clinical symptoms of smallpox: http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp
Information regarding the smallpox vaccine: http://www.bt.cdc.gov/agent/smallpox/disease/
Information about the military smallpox vaccine program: http://www.smallpox.mil/
Teaching notes:
There are a few key points that should be evident through this activity:
- In the United States, a significant portion of the population does not have adequate access to healthcare. This would make a situation like a bioterrorist attack even worse, as the country's healthcare infrastructure is not capable of taking care of its citizens during peacetime and under more stable conditions.
- The United States does not have an effective supply of vaccines or medication to deal with a variety of scenarios if there were an Toutbreak of disease. It also takes a significant amount of time to make new vaccines using present methods, which would prolong the time in which the disease could spread
- Vaccines have changed the entire world through reducing the incidence and thus prevalence of many debilitating diseases. In the case of smallpox, vaccination campaigns were even able to eradicate the virus from the planet, except for within laboratories and tightly-controlled scientific settings. This also means that healthcare personnel are not trained to deal with diseases that have not been seen in their country for almost their entire lifetime.
- Military interests are very closely tied to domestic interests, even if they do not always seem to be so at face value.
Setting up the scenario:
1. Cut apart roles and dilemma #1 and #2. Keep them in 2 groups. Place chart paper on the wall for recording the decisions.
2. Divide the class into groups of 6 and select roles for the scenario. (A group of 7 if one will be the person who charts the decisions and acts as facilitator.)
3. Each will read their own Roles and background position about how their policies or convictions would influence their decision making. After absorbing this information individually, everyone will be briefed on the developing medical situation. The facilitator or teacher will read BRIEF #1 to the group.
4. The facilitator will pass out Dilemma #1 for each role. The dilemma is unique to their role and individually the student must make what s/he think is the best decision. Once each student has had sufficient time to read, consider and decide, s/he will write down the decision and a brief rational so that it can be held up and shared with the group later in the role play.
5. All members of the group will then briefly describe to each other who they are, their dilemma, which decision they made and why. The facilitator will record the decisions on the chart paper. They will then discuss together the implications of each person’s decision with regards to the other players, and the U.S. population.
6. The facilitator will read BRIEF #2. There will then be a second brief, The facilitator will pass out Dilemma #2 for each role. and each role will be presented with a similar but more complicated or difficult dilemma. The same process of reporting and discussing implications will conclude the exercise.
Debriefing – whole class:
7. Bring the different teams together and compare and contrast the decisions made, the evidence used and the possible 2nd and 3rd order consequences of the decisions on the local, regional, national and international communities.
8. View the Briefing slides (http://www.upmc-biosecurity.org/website/events/2001_darkwinter/dark_winter_slides.html) from Operational Dark Winter and the concerns and strategies used in the mock disaster. See also http://www.upmc-biosecurity.org/website/events/2001_darkwinter/ for the overview, summary, and script of the original simulation developed for the national government.
9. Complete student self evaluation and group evaluation using rubric.
10. Extend the simulation by completing the Table Top Emergency Response – Anthrax Release
