Opioid Crisis Response and Resilience: Results and Perspectives from a Multi-Agency Tabletop Exercise at the Pennsylvania Emergency Management Agency

Background of the Hypothetical Situation

The Lower Susquehanna Valley is experiencing a crisis developed from the belief that a new opioid being exposed to the region known as carfentanyl. Carfentanyl is an opioid roughly 100 times stronger than fentanyl and roughly 1000 times stronger than heroin. The determination of this exact drug is proclaimed, as the drug causing the outbreak is unknown, as it has not been analyzed in the laboratory. While first responders are not sure of the drug, a public outbreak has occurred, and administrators must identify how to control the outbreak.

Friday, March XX, 20XX [Assumed Hypothetical Timing to be Added, the Exercise Used a 1–2 Year Time Frame]

It is 11:00 p.m. EST on Friday, March XX, 20XX. A recent snowstorm passed over the Lower Susquehanna Valley, resulting in an inch of accumulation and icy road conditions. Over the next 24 h, an unknown crisis begins to develop within the Lower Susquehanna Valley area. In the first 8 h, over 100 calls for overdosages and five fatalities were reported in the area.

Saturday, March XX+1, 20XX

By 1:00 a.m., two fatalities are reported at York Hospital, and two healthcare workers are contained and being treated for symptoms after having been in contact with the fatalities; the emergency department has implemented a divert status.

As first responders continue to respond to the overdose, they find the crisis to be too dangerous. Between 3:00 and 3:30 a.m., 15–20 more calls are reported as an overdose. Two first responders were killed by victims after reviving them. One of the first responders is an Emergency Medical Technician (EMT) from Shrewsbury, and the other first responder is an officer of the Harrisburg Police Department. First responders begin to not enter scenes and request HAZMAT (hazardous materials) teams to respond.

By 5:45 a.m., 20 more bodies are found across the region. This is a total of 57 deaths. First responders have not been able to determine the drug that is causing this havoc. It is becoming a growing community concern that the unknown drug is viral and can be contracted through skin to skin contact.

By 6 a.m., a Penn Live story of the EMT and LEO (law-enforcement officers) fatalities has led to the news media exploding with stories about the overdose fatalities. The issue is now public, and concern grows amongst first responders and civilians in the region.

The South-Central Task Force is asked to provide resources to respond to the evolving crisis. Between 8:00 and 12:00 p.m., there are 45 fatal ODs (overdosed individuals) located throughout the lower Susquehanna Valley. These include and fatal 20 ODs in the York metropolitan area; ten in Lancaster County; ten in Carlisle; and five in the Harrisburg Capital Region. During this time, police throughout the area get a lot of phone calls requesting wellness checks of loved ones. York County activates an Emergency Operations Center in a monitoring capacity and makes a Declaration of Emergency.

From 12:00 to 3:00 p.m., ten fatal ODs are reported. From 3:00 to 11:00 p.m., there are 20 more fatal OD’s. By the evening, the crisis has gained national media attention.

Sunday, March XX+2, 20XX

Dauphin, Cumberland, and Lancaster Counties activate their Emergency Operation Centers (EOCs), as 20 more fatalities were discovered and 150 non-fatal OD calls are made. Additionally, more hospitals are putting their emergency departments on divert status, as they are unable to handle this massive workload.

The issue continues to escalate, as the deaths have rippling effects. Across the lower Susquehanna Valley, 15 children have lost both of their parents to the crisis and are under supervised custody.

By the evening, several local humane societies and veterinarians have contacted authorities regarding deceased pets. The crisis continues to escalate, as both humans and animals are being affected.

Monday, March XX+3, 20XX

By Monday morning, DEA (Drug Enforcement Administration) field agents have arrived. Governor Wolf makes a public statement on Pennsylvania’s response to the crisis. With 150 deceased, there is a pending request from the state to the federal government for a DMORT (Disaster Mortuary Operational Response Team). The overdose patients in the emergency rooms are being discharged, as hospitals are struggling to coordinate warm hand-offs to treatment centers. Three York County schools are closed, and counseling is being offered after several school students were identified among the fatal casualties. Volunteers are beginning to be operationally integrated as a part of the state’s response to the crisis.

Wednesday, March XX+5, 20XX

By Wednesday, the substance has been confirmed as carfentanyl, and the police departments begin coordinating how to track down its distribution. President Trump visits Harrisburg and York, which further strains the police force and EMT capacities. Several non-traditional partners are offering help, including local churches and the Penn State student communities. CISDs (Critical Incident Stress Debriefings) are conducted for first responders throughout the area. Multiple CYS (Children and Youth Services) agencies continue efforts around reunification, counseling services, alternative placement, educational considerations, and visitations.

Fast Forward to March XX+15, 20XX: Two Weeks After Impact and Beyond

The state authorities start to address the infrastructure needed for a sustained joint incident response of the whole community, including non-traditional partners, drug treatment centers, and homeless shelters. As the provision of outreach to those who have overdosed, with the intent of getting them into long-term treatment programs, is being discussed, the lack of capacity becomes apparent. The unfortunate need for multiple funerals of first responders has also further put a strain on available resources. The size of the economic impact of the incident becomes obviously overwhelming to cater for unforeseen expenses, such as overtime for EMS personnel, bills for bringing in resources from outside of the area, medical supply bills, among other recurring expenses.

The situation has generated a heated public debate about resources put into the opioid response. As a result, Commonwealth legislators have started to discuss potential legislative actions in the outcome of the mass fatalities to mitigate against future occurrence. Attribution efforts regarding the source of the carfentanyl are also being considered. Meanwhile, there is a high demand for testing kits and protective equipment in the responder communities.

Several members of the whole community continue to express an interest in being involved in the long-term response, raising the need for a coordinative approach. In the responder community, discussions emerge on psychological health and resilience programs, and what needs must be better addressed.