Flu at the Zoo: Emergency Management Training for the ...Flu at the Zoo 417 been affected as well. In December of 2003 two tigers and two leopards housed at a zoo in Suphanburi, Thailand

Homeland Security & Emergency Management 2014; 11(3): 415–435

Yvette Joyce Johnson*, Yvonne Nadler, Eugene Field, Maung San Myint, Marilyn Sue O’Hara-Ruiz, Anna Ruman, Steve Olson, John Arthur Herrmann, Johanna Briscoe, Marisa Hickey and James KunkleFlu at the Zoo: Emergency Management Training for the Nation’s Zoos and AquariumsAbstract: The movement of people and animals within zoos and aquariums poses a risk of zoonotic disease dissemination within human and animal populations. Flu at the Zoo is a table-top exercise designed to provide animal exhibitors and regulatory agency personnel an opportunity to evaluate their outbreak response plans. Developed for zoos and aquariums in Illinois, Indiana, and Missouri, it created a realistic scenario of an avian influenza disease outbreak. A total of 82 participants attended the exercise held in June of 2012. Representatives from each of the 16 accredited zoos and aquariums in the region attended, along with representatives from the public health, agricultural animal health, wildlife, poultry industry, and emergency management sectors. Recommendations for the participants included the need for increased training opportunities for zoo and aquarium personnel on the Incident Command System and National Inci-dent Management System. It was also recommended that communications be enhanced between zoos and aquariums and the local, state, and federal agency first responder personnel. Suggestions for improving the exercise included: pro-viding the situation manual to players in advance of the exercise and creating discussion groups based on jurisdictional boundaries so that legal authorities and policy differences across state boundaries didn’t impede the discussion.

*Corresponding author: Yvette Joyce Johnson, University of Illinois – Veterinary Clinical Medicine, 1008 W. Hazelwood Drive, 227 LAC M/C 004 Urbana, Illinois 61802, USA, Tel.: +217-333-1903, Fax: +217-244-1475, e-mail: [email protected] Nadler: Lincoln Park Zoo, Chicago, Illinois, USAEugene Field: University of Illinois U-C – Fire Safety Institute, Urbana, Illinois, USAMaung San Myint and John Arthur Herrmann: University of Illinois U-C – Veterinary Clinical Medicine, Urbana, Illinois, USAMarilyn Sue O’Hara-Ruiz: University of Illinois U-C – Pathobiology, Urbana, Illinois, USAAnna Ruman: USDA-APHIS – Veterinary Services, Springfield, Illinois, USASteve Olson: Association of Zoos and Aquariums, Silver Spring, Maryland, USAJohanna Briscoe: USDA-APHIS – Animal Care, Bethesda, Maryland, USAMarisa Hickey: National Institutes of Health – Office of Research Services, Bethesda, Maryland, USAJames Kunkle: (Retired) Illinois Department of Agriculture, Springfield, Illinois, USA

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416 Yvette Joyce Johnson et al.

Keywords: aquarium; avian influenza; captive wildlife; emergency management; outbreak response; zoo; zoonotic disease.

DOI 10.1515/jhsem-2013-0052

1 IntroductionThe nation’s zoos and aquariums form a unique ecosystem where humans, exotic wildlife, domestic animals and indigenous wildlife interact with each other on a daily basis. This interaction plays a beneficial role in global conservation efforts and environmental and biomedical teaching and research. It is estimated that 175 million people visit zoos or aquariums annually and that, 2 out of 3 adults that visit a zoo or aquarium do so with a child (Association of Zoos and Aquariums 2014). Zoos and aquariums provide a safe, entertaining environment for families to see animals up close and learn about conservation. However these benefits do not come without risk. Several reports in the literature have documented human cases of illness associated with animal contact at zoos, petting zoos, fairs, and open farms (LeJeune and Davis 2004; CDC 2005; Anderson and Weese 2012). A 2004 review cited 29 outbreaks of zoonotic disease in humans associated with animal exhibits between 1990 and 2002. It is estimated that these outbreaks resulted in approximately 651 cases of human illness (LeJeune and Davis 2004). In 2004–2005, the CDC reported 3 outbreaks of E. coli O157 associated with petting zoos, resulting in 173 cases of clinical illness (CDC 2005). The most frequently iso-lated pathogens in animal-exhibit associated outbreaks include: Cryptosporid-ium, E. coli O157, and Salmonellae (LeJeune and Davis 2004). However other pathogens have also been reported including: Giardia, Coxiella burnetti, and ringworm (Anderson and Weese 2012). In 2008, six marine mammal keepers con-tracted tuberculosis (Mycobacterium pinnipedii) from an infected colony of sea lions at a zoo in the Netherlands (Kiers et al. 2008). These reports demonstrate that movement of people and animals within zoo and aquarium ecosystems poses a risk of zoonotic disease introduction and dissemination within human and animal populations, both wildlife and domestic.

Avian influenza is among the zoonotic pathogens that have the potential to be transmitted to humans via exposure to animals at a zoo or aquarium (many aquariums house of a variety avian species and marine mammals). Since its dis-covery in 1997, 60 countries have reported cases of H5N1 influenza in birds (FAO 2010). It is estimated that over 200 million birds have died either from the disease or been euthanized to prevent spread of the disease (Alexander 2007). Zoos have



Flu at the Zoo 417

been affected as well. In December of 2003 two tigers and two leopards housed at a zoo in Suphanburi, Thailand succumbed to H5N1 influenza (Juthatip et al. 2004). In a subsequent outbreak at another zoo in Thailand, tiger-to-tiger transmission has been implicated in an outbreak of H5N1 influenza affecting 16 tigers (Roon-groje et al. 2005). The spread of H5N1 influenza into European bird populations has prompted efforts to develop avian influenza contingency plans, enhanced biosecurity measures and vaccination programs for zoos within member coun-tries of the European Union (Redrobe 2007).

In the US, the Zoo Animal Health Network (ZAHN), Association of Zoos and Aquariums (AZA) and USDA Animal Care program developed the 2009 USDA-APHIS-AZA Management Guidelines for Avian Influenza: Zoological Parks and Exhibitors Outbreak Management Plan version 322 (USDA APHIS 2009). The plan offers guidance to zoos and aquariums faced with preparing for and responding to an outbreak of highly pathogenic avian influenza (HPAI) within their collections. This outbreak management plan was developed to provide USDA-APHIS Emer-gency Management and regional and local emergency management staff with the framework for decision-making if a disease emergency were to impact a zoo.

To accommodate the various sizes of zoos and aquariums, their collections, their local environments and the diverse population of patrons served, the out-break management plan was designed to be scalable, flexible and adaptable. The intent of the 2009 Avian Influenza Outbreak Management Plan was for individual zoological institutions to incorporate the proposed strategies into routine proce-dures as well as to develop additional specific plans for their facility. Additionally zoo and aquarium staffs have been encouraged to coordinate with local, regional and federal agency representatives in human, livestock and wildlife health to get pre-approval of their specific mitigation and prevention plans.

The Flu at the Zoo exercise provided a unique training and program evaluation opportunity in zoonotic disease outbreak preparedness for zoos and regulatory agencies charged with responding to such an outbreak. Although animal exhibi-tors may participate in state and federal natural disaster exercises and in 2012 a zoo-based Foot and Mouth Disease exercise was conducted in Kansas (Johnson 2012), to the authors’ knowledge no other exercises targeting response to a simu-lation of a zoonotic disease event affecting zoo collection animals and personnel in the US, have been reported in the literature. Funded in part by a USDA-APHIS-Animal Care grant, this exercise was developed for the 16 AZA accredited zoos and aquariums located in Illinois, Indiana, and Missouri. The Midwestern location for the initial exercise encompassed large and small zoological institutions in urban, suburban and rural locations, some with relatively close proximity to livestock and poultry production facilities (see Figure 1 for a map of the density of produc-tion birds (chickens, turkey, and game birds) and participating zoos within the




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Flu at the Zoo 419

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Figure 2 Map of US Migratory Waterfowl Flyways Obtained from: http://www.dnr.state.oh.us/tabid/19961/Default.aspx

region). Some of the participating zoos were located within major migratory bird flyways (see Figure 2 for migratory bird flyways within the USA) and others were close to ecologically sensitive areas with indigenous wildlife that needed protec-tion from the potential impact of a widespread outbreak of avian influenza.

2 Materials and Methods

2.1 Exercise Planning and Development

The goals of Flu at the Zoo were: 1) to develop a discussions-based exercise fea-turing a simulated outbreak of a zoonotic foreign animal disease that could be adapted to a variety of types of animal exhibitors in different locations; 2) to enhance communication among stakeholders by bringing local, state, and federal animal and public health regulatory agencies together with zoo and aquarium personnel for a discussion of zoonotic foreign animal disease response; 3) and to



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identify areas of the 2009 Avian Influenza Outbreak Management Plan in need of improvement. The Homeland Security Exercise and Evaluation Program (HSEEP) approach was applied to the development and conduct of this exercise because it provides a set of guiding principles for exercise programs, as well as a common approach to exercise program management, design and development, conduct, evaluation, and improvement planning (US Department of Homeland Security 2007a), making it a suitable format for developing a reproducible exercise for use in multiple states across the country. In the first phase of exercise development, a multidisciplinary exercise planning team was assembled from major stakeholder groups that would respond to a zoonotic foreign animal disease (FAD) outbreak including the zoo community, state and federal departments of agriculture, animal health, public health, and emergency management, the poultry industry, and the academic community.

Exercise planning occurred over a twelve month period. A one-day, in-person facilitated, discussion-based exercise was developed during the first and second quarters of the project period. Enrollment of participants, preparation of the venue, and refinement of discussion questions for the exercise were conducted during the third quarter of the project. The exercise was conducted and After Action and Improvement Plan reports were completed during the fourth quarter of the project period.

Development and conduct of this exercise occurred when the HSEEP was operating under 2007 guidelines (US Department of Homeland Security 2007a). At this time, the National Planning Scenarios (US Department of Homeland Security 2006) and the National Preparedness Guidelines (US Department of Homeland Security 2007b) steered the focus of homeland security toward a capabilities-based planning approach. Capabilities-based planning focuses on planning under uncertainty and takes an all-hazards approach to planning and prepara-tion that builds capabilities which can be applied to a wide variety of incidents. States and urban areas used capabilities-based planning for their homeland secu-rity efforts by comparing their current capabilities against the Target Capabilities List (TCL) and the critical tasks of the Universal Task List (UTL) (US Department of Homeland Security 2007c). This approach identified gaps in current capabili-ties and focused efforts on developing priority capabilities and tasks for the juris-diction. The Target Capabilities approach has since been replaced with the Core Capabilities outlined in PPD-8 (Obama 2011) which became effective after the conclusion of this exercise (US Department of Homeland Security 2013). The prior terminology will be applied for this manuscript since it was in place at the time of the exercise. The purpose of the Flu at the Zoo exercise was to measure and validate three target capabilities and their associated critical tasks. The selected target capabilities were:



Flu at the Zoo 421

– Epidemiological Surveillance and Investigation – Food and Agriculture Safety and Defense – Animal Disease Emergency Support

Capabilities-based planning allowed exercise planning teams to develop exercise objectives and observe exercise outcomes through a framework of specific action items that were derived from the Target Capabilities List (TCL). The capabilities listed above formed the foundation for the organization of all objectives and observations in this exercise. Additionally, each capability was linked to several corresponding activities and tasks to provide additional detail.

2.2 Exercise Objectives

Exercise design objectives focused on improving understanding of a response concept, identifying opportunities or problems, and achieving a change in atti-tude. Based upon these objectives, the exercise planning team decided to demon-strate the following capabilities during this exercise:

– Participants will discuss the ability of local, state, and federal agencies to establish control of a HPAI outbreak in each institution as it spreads toward each zoo, until the virus affects collection specimens, and potentially employees. (Note: While it is highly unlikely that this scenario would play out in every zoo simultaneously, for an individual institution this could be a highly likely scenario.)

– Participants will discuss the ability of local, State, and Federal agencies to establish control of zoo animals and animal products to restrict movement of people, animals, supplies and products, and equipment in and out of control areas including zoological parks.

– Participants will discuss the ability of local, State, and Federal agencies to establish and coordinate a cleaning and disinfection program targeting zoo-logical parks in the affected areas including personnel, equipment, and sup-plies according to current USDA APHIS protocols.

– Participants will discuss applicable references to the 2009 Avian Influenza Outbreak Management Plan.

2.3 Exercise Structure and Format

The exercise created a realistic, progressive scenario, spread over three modules (see Figure 3 for an exercise scenario timeline of events), of an avian influenza




disease outbreak including an initial case of H5N1 zoonotic avian influenza identified in the first exercise module, in free-living waterfowl, at a site that was remote from the participating zoos. In the second module, the same strain of H5N1 avian influenza had spread to free-living birds in close proximity to the participat-ing zoos. In the third and final module, clinical H5N1 avian influenza had been diagnosed among zoo collection animals and animal caretakers at the participat-ing zoos. Outbreak scenario details were presented to the participants in a com-bined discussion session and also disseminated in a written Situation Manual at the start of the exercise. After the presentation of each module in the exercise, participants were divided into three smaller groups for discussion. Group assign-ments were made prior to the exercise date based upon the advance registration list to ensure that groups had balanced numbers and at least one representative from the state, federal, and industry stakeholder groups present. Zoo personnel were divided into 3 groups of approximately equal size and other stakeholders were assigned to groups ensuring that each group had at least one representa-tive from each of the following sectors: public health; poultry industry; wildlife; emergency management; state-level agricultural animal health and welfare; and federal-level agricultural animal health and welfare. Due to the limited number of registered participants in some of the sectors (i.e., public health, and wildlife) and the relative over-representation of zoological facilities and regulatory per-sonnel from Illinois, group assignment was not based on geographic distribution. Groups one and two had 23 participants assigned and Group 3 had 21 participants assigned. Group facilitators moderated the discussion and offered sample ques-tions for assessment of response plans. Each facilitation team consisted of at least one person with regulatory experience related to animal health and at least one veterinarian. Three exercise evaluators circulated between discussion groups, one each with expertise in: operations and management at zoos and aquariums; federal FAD response and infectious disease control; and emergency operations

Welcome andintroductions

9:00am 9:30am 11:15am 11:45am 1:30pm 3:30pm 4:30pm

Closingcomments

and Adjourn

Working lunch

Module 1: Outbreak Day: 1High Path Avian Influenzais detected in a wild bird inSouthern Illinois Module 2: Outbreak Days: 2–10

High Path Avian Influenza isdetected in free-living wild birdswithin your municipality

Module 3: Outbreak Days: 11–18High Path Avian Influenza is detectedin collection birds and animal care personnel

Player hot-wash

Figure 3 Timeline of Scenario Events and Participant Activities for the Flu at the Zoo One Day Tabletop Exercise Held on June 6, 2012 in Bloomington, Illinois.



Flu at the Zoo 423

and incident command structure and function. HSEEP exercise evaluation guide-lines (EEGs) that were modified to fit the exercise scenario were used by exer-cise evaluators to assess how well the exercise objectives were met. Three EEGs were adapted to assess this exercise: 1338 Animal Disease Emergency Support, 1349 Epidemiologic Surveillance and Investigation, and 1353 Food and Agricul-ture Safety and Defense. At the conclusion of small group discussions for each module, a combined discussion session was held to summarize group findings. A final combined session was held to assess overall participant findings from the exercise and to share the perspectives of the exercise evaluators with the partici-pants. This discussion session that occurs immediately following the conclusion of the exercise play is commonly referred to as a player “hot-wash”.

In addition to the hot-wash, participant feedback forms were used to assess the effectiveness of the exercise. The feedback form consisted of seven open response questions and eight Likert scale questions with ordinal response categories ranging from 1–5, with 1 indicating strong disagreement and 5 indicating strong agreement. Exercise participants represented a wide variety of stakeholder groups (zoological personnel, animal and human health regulatory personnel, agricultural industry personnel, etc). To identify differences in perception between zoological personnel and other groups, participant responses were stratified by stakeholder groups into 2 categories: zoological personnel and non-zoological personnel.

Open-ended responses were recorded and the results summarized to provide descriptive information about participant perceptions of the exercise strengths, exercise areas in need of improvement, response areas in need of improvement and participant recommendations for strategies and target personnel required to achieve the desired improvement. Statistical analysis of Likert scale responses was conducted using the Fisher’s Exact test to compare the feedback responses by the binary stakeholder group category. Likert scale responses were also grouped into 2 categories. Scores for “agree” and “strongly agree” (4 and 5) were grouped together and scores from “no opinion” to “strongly disagree” were grouped together (3, 2, and 1).

3 ResultsThe exercise was held on June 6, 2012 at the Illinois Farm Bureau in Bloomington, Illinois. The geographic scope of the exercise was greater than initially antici-pated. Exercise participants hailed from the three target states (Illinois, Indiana, and Missouri) and representatives from seven additional states were also in attendance (Figure 4). A total of 80 participants (67 players, six controllers/facili-




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Flu at the Zoo 425

tators, three evaluators, and four observers) attended the exercise representing each of the stakeholder groups identified by the exercise planning team. The 67 players consisted of one to two representatives from all 16 of the AZA accredited zoos and aquariums within the target states and one representative each from 2 additional zoos outside the three state region providing 26 zoo representatives and a representative from the only accredited aquarium in the target area, for a total of 27 zoo and aquarium representatives. There were 17 state agency rep-resentatives and 17 federal agency representatives consisting of participants in the: public health (2 state and 1 federal); agricultural animal health and welfare (12 state and 12 federal); wildlife (1 state and 2 federal); and emergency manage-ment sectors (2 state and 2 federal). In addition there were 6 players from indus-try organizations representing the zoological (1), veterinary (1), and poultry (4) industry stakeholder groups.

3.1 Exercise Evaluator Feedback

Detailed results of the feedback received from the exercise evaluators are sum-marized in Table 1. Briefly, exercise evaluators noted that participant strengths included: awareness of the 2009 Avian Influenza Outbreak Management Plan; positive relationships between USDA Animal Care inspectors and zoological personnel; and knowledge of the epidemiology and pathophysiology of highly pathogenic avian influenza. Areas for zoonotic disease response improvement among zoological personnel identified by the evaluators were: improved com-munication with local, state, and federal stakeholder groups in the event of an emergency; lack of awareness of National Incident Management System and Incident Command System among zoological personnel; and lack of knowledge regarding state and federal resources available to assist in emergency response in a zoonotic foreign animal disease event affecting a zoological institution or aquarium.

3.2 Participant Feedback

A total of 46 (61.3%) of players and facilitators (total = 75) completed the submit-ted the participant feedback form. The results of the open ended questions are summarized in Table 2. The strengths of the exercise most frequently stated were: the style, format and scenario as depicted in the exercise, the quality of the dis-cussion, and the types of stakeholder groups and agencies participating in the exercise.




Table 1 Exercise Evaluator Feedback for Epidemiological Surveillance and Investigation.

Strengths Weaknesses

A. Epidemiological surveillance and investigation

– The participating zoological institutions had some type of emergency response plans for use in the event of an avian influenza threat.

– Zoos and aquariums need to develop pre-outbreak communications strategies with the media and state and local responders.

– Most institutions had a good working relationship with USDA staff.

– Zoos and aquariums need to develop a flowchart and decision tree that explains how surveillance tests will be conducted, by whom and how surveillance tests will be conducted, by whom and how results will be communicated.

– Zoos and aquariums recognized that their need to be prepared for an emergency is paramount.

– Zoos and aquariums recognized that they have the potential to be critical players during a disease outbreak.

B. Food and agriculture, safety and defense

– Exercise participants had a fairly good understanding of the basic science of HPAI.

– Notification of a foreign animal disease event near their facility?

– Most zoos and aquariums recognized the need to appropriately scale up biosecurity during a disease outbreak.

– Would animal exhibitors or responder agencies have responsibility for public messaging during an outbreak affecting their facility?

– There was a strong desire expressed during the exercise to be part of the decision making process at the local Emergency Operations Center (EOC) during an outbreak.

– Zoos and aquariums need to identify whether regulatory agencies or the exhibitors would be responsible for increased surveillance and testing during an outbreak.

– Communications was recognized by zoo and aquarium participants as key to a successful response.

– There is a need for most zoos and aquariums to do more specific and detailed emergency planning.

– Concerns raised about communication included: How and when would exhibitors receive

C. Animal disease emergency support

– The appropriate people, organizations, and agencies were present to discuss the multifaceted response required for a potential HPAI outbreak.

– Training on the Incident Command System (ICS) and the National Incident Management System (NIMS) is generally lacking in the zoological and aquarium communities.

– Expertise and abundant resources were readily available from the federal and state governments to assist animal exhibitors in their outbreak response.

– Zoos and aquariums need to work with local emergency response agencies in their planning and preparedness in the “all-hazards” planning arena.

– The dialog during the exercise provided an outstanding base for creating a standardized response protocol that can be adopted by animal exhibitors of any size.

– Animal exhibitors should identify additional resources likely to be made available from state and federal sources and determine their usefulness as an added capability in response planning



Flu at the Zoo 427

Table 2 Summary of Open-response Questions from Flu at the Zoo Participant Feedback forms for the Table-top Exercise Conducted on June 6, 2012 in Bloomington, Illinois. n = 46.

Question Responses ≥ 5 Number of responses

List 3 strengths of the exercise Presence of various stakeholder groups, institutions

40

Quality of communication or discussion 28 Style, format, scenario, organization of

the exercise 23

Identification of deficits; knowledge gaps or deficiencies in current plans

18

List 3 areas in need of improvement of the response of an institution or within the exercise?

Improved communication 40

Additional response, ICS, training and information

18

Additional information needed about other responders in an outbreak

14

Exercises need to take place over a longer period of time

6

Is there anything you saw in the exercise that the evaluator(s) might not have been able to experience, observe, and record?

No 40 Yes 1

Identify corrective actions that should be taken again, with the response or the exercise?

Improved Communication 16

Additional response, ICS, training and information

14

Describe the corrective actions that relate to your area of responsibility

Zoos, regulators, and outbreak responders need to meet

8

Enhance communication plans 7List the applicable equipment, training, policies, plans, and procedures that should be reviewed, revised, or developed

My institution or state’s outbreak response plan needs to be updated/revised

10

Approximately eighty-seven percent (40/46) of the participants indicated that the area in their response plans most in need of improvement was an under-standing of communication channels in a foreign animal disease (FAD) emer-gency. This was also the most often cited area in need of improvement during the exercise discussion sessions. Forty percent of participants specifically stated that they believed zoo personnel needed ICS and or NIMS training (18/46).




The results of the Likert scale questions are summarized in Table 3. The ques-tions that received high scores from participants were: the structure and organi-zation of the exercise; the plausibility of the scenario; the appropriateness of the exercise for someone in their position; and having the right mix of disciplines represented at the exercise. Positive scores were also received for the other ques-tionnaire items; however, compared to the other five questions, they were some-what lower for three items: the facilitator and controllers’ knowledge of the area of play; ability to keep the exercise on target; and usefulness of the documenta-tion provided. These questions were also scored significantly lower by zoo per-sonnel than by non-zoo personnel. Participants agreed less strongly that their capabilities had been improved by the exercise and that they felt better prepared to respond to an outbreak of avian influenza after the exercise.

4 DiscussionFlu at the Zoo was able to accomplish its three stated goals: 1) to develop a discus-sions-based exercise featuring a simulated outbreak of a zoonotic foreign animal disease that could be adapted to a variety of types of animal exhibitors in dif-ferent locations; 2) to enhance communication among stakeholders by bringing local, state, and federal animal and public health regulatory agencies together with zoo and aquarium personnel for a discussion of zoonotic foreign animal disease response; and 3) to identify areas of the 2009 Avian Influenza Outbreak Management Plan in need of improvement.

4.1 Exercise Development

Overall, respondents and evaluators provided positive feedback on the exercise. The player hot-wash at the conclusion of the tabletop exercise and the participant feedback forms both indicated that participants were pleased with the structure and format of the exercise and the quality of the discussion that was generated. There were two areas in which the exercise could have been improved from the perspective of the personnel from zoos and aquariums: facilitator knowledge and keeping the exercise on track; and exercise documentation. Providing the docu-mentation in advance of the exercise is recommended for those conducting the exercise in the future. Discussion groups should also be arranged so that zoo and aquarium players are grouped with the regulatory agency personnel from their jurisdiction. This will require increased recruitment of public health, wildlife,



Flu at the Zoo 429

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emergency management, and agricultural industry personnel for participation in future exercises.

Although the focus of this exercise was the zoos in this Midwestern region, the findings of this outbreak exercise and the dissemination of the exercise mate-rials, after action reports and improvement plans are applicable to other zoos and aquariums interested in executing outbreak response training and evalua-tion exercises. Application of HSEEP guidelines in the development and conduct of the exercise provided an exercise structure and format that can be repeated in different regions with a variety of animal exhibitors. Participant and evaluator comments indicated that the content and structure of Flu at the Zoo would be satisfactory to the wide variety of stakeholder groups targeted by the exercise. Improvements in the exercise structure, format, conduct, and documents will enhance the quality of the exercise and facilitate its use as a tool for emergency preparedness among animal exhibitors in different regions. Based on partici-pant scores on the feedback forms, areas for improvement in the exercise itself included: facilitator and controllers’ knowledge of the area of play and ability to keep the exercise on target. This perception may have been due to factors inherent in the design and structure of the exercise. Definitive answers were not always available for some of the regulatory issues discussed because of policy differences across state boundaries and uncertainty about regulatory authority and actions that may be taken in an emergency situation. This would also explain why zoo personnel in particular scored these items lower than non-zoo personnel who were primarily state and federal regulatory officials. Regulatory differences across jurisdictions also contributed to moving discussion away from the target issues at times. One way to address this limitation in future exercises would be to divide the small discussion groups by state so that regulatory agency repre-sentatives are in the same discussion group as the zoo and agricultural industry representatives from their jurisdiction. In an effort to maintain balanced numbers in each discussion group for Flu at the Zoo, regulatory agency representatives were spread across discussion groups and often placed with zoo personnel from differing jurisdictions.

Usefulness of the documentation provided was also identified as an area for improvement of the exercise. This may have been attributable to the fact that participants did not have access to the exercise scenario or discussion questions prior to the start of the exercise. During the player hot-wash, zoo personnel in particular expressed a desire to have had access to the Situa-tion Manual prior to the exercise so that they could prepare. Participants were encouraged to review and bring their institutions’ outbreak management plan to the exercise for reference. However, the planning team decided not to provide the Situation Manual in advance in an effort to simulate participant



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responses to an unexpected event. Since this was a discussions-based exer-cise and not a functional exercise, future presentations of the exercise should perhaps include advance distribution of the Situation Manual to address this concern by participants.

The limited scope and discussions-based format of the exercise may have caused some participants to give the exercise lower scores for improving their outbreak management capabilities and preparedness. Participants from zoos, and regulatory agencies were able to identify deficiencies in their response plans, however establishment of corrective actions were not goals of this exercise. These issues will have to be addressed through future training, response planning and functional exercises to achieve the long-term goals of improved outbreak response, utilization of available resources, and enhanced outbreak prepared-ness within the zoological community.

This issue is a challenge to many in the emergency response and prepared-ness field and for the zoological community in particular. The HSEEP recom-mends a multi-year iterative cycle for response planning, training, exercise and evaluation in which each year the response plan and the training are enhanced and the exercises increase in complexity. Participants can then enter the exer-cise with the knowledge that deficiencies noted in this year’s exercise will be addressed in next year’s training. The availability of continued funding for out-break response preparedness in zoos and aquariums had not been established at the time that Flu at the Zoo was conducted. In response to the outcomes derived from Flu at the Zoo, funding was secured to build on that foundation and continue outbreak response preparedness training opportunities for the zoo and aquarium community allowing the establishment of the HSEEP rec-ommended multi-year cycle of planning, training, and conduct of increasingly complex exercises.

4.2 Enhancing Communication Between Wide Variety Stakeholder Groups Involved in Zoonotic Foreign Animal Disease Response

The dialog during this exercise provided an outstanding foundation for foster-ing mutual understanding between zoo personnel and other responding agencies on roles and responsibilities and capabilities during a disease outbreak affecting the health of humans and animals. Developing an effective response plan for a zoonotic foreign animal disease event involving a zoo or aquarium will require a coordinated response by a wide range of local, state, and federal agencies along with zoological personnel.




Participants identified a need for improvement in communication between all of the stakeholders who would be involved in an outbreak response and the need for additional training opportunities for zoo and aquarium personnel in the Midwest. The specific type of training needed, identified most frequently was incident command structure (ICS). The participant feedback forms and exercise evaluators both indicated that zoo personnel varied widely in their awareness of incident command structure and operations. Zoo personnel were more likely than non-zoo personnel to indicate a need for additional emergency response or ICS training and information. They also noted that communications challenges and insufficient coordination of response activities across agencies and institutions may serve as potential barriers to a timely and effective FAD outbreak response involving zoos or aquariums.

Documented outbreaks of human illness associated with animal exhibits demonstrate the potential for disease to disseminate between human and animal populations in these settings and illustrate the need for zoos, aquariums, and responder agencies to incorporate planning for these incidents into their all-hazards approach for emergency response. One means of facilitating collabora-tive planning across stakeholder groups is to ensure that everyone is speaking the same language. ICS training provides a common language used by the wide variety of first responders that would be called upon to respond to an infectious disease event affecting human and animal populations. Although ICS training is available online, zoo and aquarium personnel participating in the Flu at the Zoo exercise indicated that this was an area in which additional training oppor-tunities were needed. One reason zoo personnel may be reluctant to participate in ICS training is that they may fail to see how the natural disaster prepared-ness examples featured in the online exercises relate to their daily activities at the zoo or aquarium. Developing zoo-specific examples of incidents in which ICS implementation would be a useful response tool, would be one way of addressing these concerns and encouraging the routine use of ICS into the management of events at a zoological institution. In this manner personnel will be familiar with the approach when it is applied to an emergency that requires the intervention of other responder agencies.

4.3 Improvement of the 2009 Avian Influenza Response Plan

The areas for improvement in emergency preparedness by the exercise were the foundation for a revision of the 2009 Avian Influenza Outbreak Management Plan. Recommendations in the After Action Report for Flu at the Zoo included the need for increased training opportunities for zoological community personnel



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on the Incident Command System and National Incident Management System. In addition, it was recommended that communications be enhanced between zoos and aquariums and the local, state, and federal agency personnel that would serve as first responders in a zoonotic foreign animal disease event. Since the conclusion of Flu at the Zoo, two projects have been initiated in response to the identification of those areas for improvement. “Flu at the Zoo 2” was devel-oped to create and disseminate zoo-specific ICS 100 and ICS 200 training oppor-tunities. After certification for ICS 100 and 200 zoo personnel were invited to participate in an internet-based functional avian influenza response exercise. The second project entitled, “Zoo Ready” will feature a regional workshop for zoo and aquarium personnel and their state and federal responder agencies to discuss communication channels, regulatory authority, and opportunities for collaborative response planning in advance of a foreign animal disease inci-dent. In addition to the workshop, “Zoo Ready” builds upon “Flu at the Zoo 2” by presenting zoo-specific ICS training to a national audience at the mid-year Conference of the Association of Zoos and Aquariums to be followed by a nation-wide internet based functional exercise on avian influenza preparedness in zoos and aquariums. A new, more complex functional exercise is in development for testing at the regional level based on the lessons learned from the previous Flu at the Zoo exercises.

5 ConclusionFlu at the Zoo was a unique table-top exercise in emergency preparedness because it targeted the zoological community and featured a simulation of a disease event in which both captive animal health and public health were threatened. Stake-holders participating in the exercise included: zoo and aquarium personnel; agricultural industry representatives; and state and federal regulatory agencies. Examples of human outbreaks of disease associated with animal exposures illus-trate the need for increased communication and collaboration between animal exhibitors and those charged with the protection of public health and those charged with the protection and regulation of the health and welfare of animals (whether they are agricultural animals, domestic wildlife, or captive wildlife). Application of HSEEP guidelines as a tool for exercise development and evalu-ation provided a reproducible exercise format that is standardized yet flexible enough to adapt to a variety of types of animal exhibitors in different locations. Despite the wide range of stakeholders participating in the exercise, the structure and format were well received and the lessons learned from the exercise have




contributed to emergency preparedness in the zoo and aquarium community and served the basis for subsequent preparedness exercises.

Acknowledgments: This project was funded by Cooperative Agreement Number No. 11-6100-0066-CA between the USDA-APHIS-AC and the University of Illinois. The authors would like to thank Dr. Gay Miller and Mr. Keith Gehrand for serv-ing as exercise evaluators and Mr. William Brown for development of maps and spatial data in support of the exercise. In addition, the authors would like to thank the all of our participating zoological institutions, and stakeholder group representatives including the Association of Zoos and Aquariums, the Multistate Partnership for Security in Agriculture, the Illinois Farm Bureau, USDA APHIS divisions of Animal Care, Veterinary Services, Wildlife Services, NIH and all of the state, local, and federal agencies whose personnel contributed time and resources to the conduct of this exercise.

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Documents

Flu at the Zoo: Emergency Management Training for the ...Flu at the Zoo 417 been affected as well. In December of 2003 two tigers and two leopards housed at a zoo in Suphanburi, Thailand