Cases in Simulated Disaster Medicine | Chapter 40

Document Type

Book Chapter

Publication Date

2-6-2026

Editor

Andrew Milsten and John Broach

Abstract

This case presents a simulated scenario of a bioterrorism attack involving the deliberate release of Francisella tularensis (tularemia) in rural farming communities. The scenario challenges participants to manage an overwhelming influx of patients presenting to a rural hospital’s emergency department with varying symptoms of tularemia, including ulceroglandular disease, pneumonia, and sepsis. The hospital faces severe limitations in critical care resources, such as ventilators and ICU beds, requiring a transition from conventional to crisis-level care. Participants are tasked with diagnosing tularemia without on-site diagnostic tools, stabilizing patients, and utilizing emergency management resources, such as the hospital incident command system (HICS). The scenario also emphasizes the need for effective communication with public health agencies, the recognition of a bioterrorism event, and ethical decision-making in allocating scarce resources. Additionally, participants must navigate the complexities of national emergency preparedness and response systems to mitigate the impact of the attack on healthcare operations.

First Page

271

Last Page

284

Chapter Title

Chapter 40 - Tularemia Outbreak in a Resource-Limited Setting

Publisher

Cambridge University Press

ISBN

[9781009279024, 9781009279017]

Rights

© Cambridge University Press 2026

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