A simulation exercise (SimEx1) or emergency preparedness exercise2 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 tabletop4 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 Polaris10. The fictional disease being tested was "mammothpox"1112 The outbreak started with a pathogen from permafrost12. 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
References
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.
- 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
- 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".
- 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.