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A simulation exercise (SimEx[1]) or emergency preparedness exercise[2] is a public health simulation of a hypothetical disaster used to test response capacity. It is similar to military exercises.
Types
The World Health Organization categorises simulation exercises into four categories: tabletop exercise, drill, functional exercise, and full-scale exercise listed in increasing complexity (amount of preparation and resources required).[3] The European Centre for Disease Prevention and Control considers an additional type: the orientation exercise which it places before tabletop exercise.[4]. The discussion-based exercises (orientation and tabletop[4] are recommended as a starting point before conducting operation-based exercises (the other three types).[2]
Format
During an exercise, injects are provided.[5] These are updates to the scenario in the form of emails, news articles, telephone calls and so on.[6] The master scenario events list contains an overview of which injects are used when.[7] The exercise is followed up by a debrief, including a “hot” debrief immediately after the exercise.[8]
Scenarios
Disease outbreaks
NSW Health hosted an influenza pandemic exercise called XFG in 2008.[9] The World Health Organization hosted an exercise in 2025 called Polaris[10]. The fictional disease being tested was “mammothpox”[11][12] The outbreak started with a pathogen from permafrost[12]. The same year, UK Health Security Agency held an exercise called Pegasus.[13] The fictional disease in this exercise was “EV-D68”.[14]
| Name | Year | Facilitator | Disease |
|---|---|---|---|
| Exercise Cygnus | 2016 | UK Government | influenza |
| Exercise Alice | 2016 | UK Government | Middle East respiratory syndrome |
| Exercise Clade X | 2018 | Johns Hopkins Center for Health Security | disease X |
| Crimson Contagion | 2019 | US Department of Health and Human Services | influenza |
Mass casualty events
In 2017 an exercise called Elsa considered a major incident leading to many casualties.[2] The same year, an exercise named Socrates considered a mass casualty event.[2]
Natural disasters
A 2011 simulation imagined the 365 Crete earthquake happening again.[15] In 2012 an exercise simulating destruction of the Isthmus of Corinth as a result of an earthquake was held.[16]
See also
References
- ^ Mahdi, Syed Sarosh; Jafri, Hafsa Abrar; Allana, Raheel; Battineni, Gopi; Khawaja, Mariam; Sakina, Syeda; Agha, Daniyal; Rehman, Kiran; Amenta, Francesco (24 May 2023). “Systematic review on the current state of disaster preparation Simulation Exercises (SimEx)”. BMC Emergency Medicine. 23 (1): 52. doi:10.1186/s12873-023-00824-8.
- ^ a b c d Skryabina, Elena A.; Betts, Naomi; Reedy, Gabriel; Riley, Paul; Amlôt, Richard (2020). “The role of emergency preparedness exercises in the response to a mass casualty terrorist incident: A mixed methods study”. International Journal of Disaster Risk Reduction. 46. doi:10.1016/j.ijdrr.2020.101503. PMC 7709486.
- ^ WHO Simulation Exercise Manual, World Health Organization, 2017
- ^ a b Handbook on simulation exercises in EU public health settings – How to develop simulation exercises within the framework of public health response to communicable diseases, European Centre for Disease Prevention and Control, 2014
- ^ Houareau, Claudia; Spieker, Clara; Grote, Ulrike; Perseke, Knut; an der Heiden, Maria; Caglar, Robert; Wolter, Amrei; Connolly, Máire A.; Hayes, Jessica S.; Stein, Mart; Kaluza, Benjamin; Overmeyer, Maike; Rexroth, Ute (2025). “The PANDEM-2 Simulation Exercise: Training the Coordinated Response to a Large-Scale Pandemic in 2 European Public Health Emergency Operations Centers”. Disaster Medicine and Public Health Preparedness. 19. doi:10.1017/dmp.2024.298.
- ^ Grance, Tim; Nolan, Tamara; Burke, Kristin; Dudley, Rich; White, Gregory; Good, Travis, Guide to Test, Training, and Exercise Programs for IT Plans and Capabilities
- ^ Homeland Security Exercise and Evaluation Program (PDF), 2020
- ^ Dausey, David J.; Buehler, James W.; Lurie, Nicole (29 May 2007). “Designing and conducting tabletop exercises to assess public health preparedness for manmade and naturally occurring biological threats”. BMC Public Health. 7 (1): 92. doi:10.1186/1471-2458-7-92. PMC 1894789.
- ^ Eastwood, Keith; Durrheim, David; Merritt, Tony; Massey, Peter D.; Huppatz, Clare; Dalton, Craig; Hope, Kirsty; Moran, Lucille; Speare, Richard; Farrar, Kris (2010). “Field exercises are useful for improving public health emergency responses”. Western Pacific Surveillance and Response Journal. 1 (1): 12–18. doi:10.5365/WPSAR.2010.1.1.003. PMC 3729048.
- ^ Simmons, Laura (7 April 2025). “Exercise Polaris: The WHO Just Ran A 2-Day Pandemic Preparedness Exercise”. IFLScience.
- ^ Gooch, Bryony (15 April 2025). “WHO tests the world’s pandemic response with fictional ‘mammothpox’ outbreak”.
- ^ a b Cullinan, Maeve; Scott-Geddes, Arthur (15 April 2025). “WHO tests pandemic response with Arctic ‘mammothpox’ outbreak”.
- ^ “Pandemic Preparedness: Exercise PEGASUS”. 4 November 2025.
- ^ Nuki, Paul; Newey, Sarah; Cullinan, Maeve (25 November 2025). “Schools locked down again in secret pandemic drills”.
- ^ Kalligeris, N.; Flouri, E.; Okal, E.; Synolakis, C. (2012). “The AD 365 earthquake: high resolution tsunami inundation for Crete and full scale simulation exercise”. Geophysical Research Abstracts. 14 (EGU2012-11787).
- ^ Zygoura, A.; Sidiropoulos, K.; Vergopoulou, P.; Argyropoulos, G.; Imertziadis, C.; Kapnopoulos, H.; Koukopoulos, P.; Kostopoulos, I.; Letsios, G.; Papalouizos, C.; Shinarakis, C.; Fotopoulos, K. (2005). “Development and Implementation of a Simulation Exercise for the Special Unit for Disaster Medicine in Collaboration with the “Hellenic Volunteer Rescue Team” Non-Governmental Organization”. Prehospital and Disaster Medicine. 20 (S1): 63. doi:10.1017/S1049023X00013327.
