Healthcare System
AMR Surge — Pan-Resistant Infection in Critical Care
A pan-resistant organism spreads through hospital critical-care units.
Duration
120 min
Injects
5
Audience
Hospital executive, infection prevention & control, critical care, regional health leads
Situation
A carbapenem-resistant organism with resistance to all last-line antibiotics is detected in an ICU. Within two weeks it has spread across three units and a sister hospital via patient transfers. There is no reliable therapeutic option for the most severe cases, and elective activity is at risk.
Exercise objectives
- Test infection prevention & control escalation and the decision to restrict admissions or transfers.
- Exercise the trade-off between outbreak control and maintaining essential and elective care.
- Evaluate diagnostic stewardship and the speed of resistance detection.
- Rehearse transparent communication with patients, staff and the public.
Capability stress
How hard this scenario tests each of the 10 benchmark dimensions (1–5).
Foresight lens
Getting ready for a threat that HAS a reference class — one that resembles something we have seen (COVID, influenza, known AMR). Plans, playbooks and drills work because the past is a guide.
TUNA profile
Assumptions this scenario windtunnelsfull register →
A8Diagnostics can identify a novel or fully drug-resistant pathogen.
Sensitivity: high · TUNA: N
A5Readiness is a controllable quantity you can hit as a target.
Sensitivity: high · TUNA: —
Scenario parameters
Illustrative planning figures for discussion — not operational data.
Organism
Carbapenem-resistant Enterobacterales, pan-resistant profile
Transmission
Contact / environmental reservoirs, patient transfers
Therapeutic options
None reliable for severe disease
Detection lag
48–72h for full resistance profile
Affected units
3 ICU/HDU units + 1 transfer hospital
Roles at the table
Chief Medical Officer (Trust)
Owns the balance between outbreak control and service continuity.
IPC Lead
Directs isolation, cohorting, screening and environmental control.
Critical Care Lead
Manages capacity, transfers and treatment under therapeutic scarcity.
Microbiology/Diagnostics Lead
Owns rapid resistance detection and stewardship.
Communications Lead
Manages disclosure to patients, staff and the public.
Inject timeline
- Day 0Index case
A pan-resistant organism is confirmed in one ICU patient.
- Day 4Second unit
A screening sweep finds colonised patients in a second unit.
- Day 8Transfer spread
A transferred patient seeds an outbreak at a sister hospital.
- Day 11First attributable death
A severe case dies with no viable treatment; family and media questions follow.
- Day 14Capacity pressure
Isolation demand forces a decision on pausing elective surgery.
Decision points
D1Do you close units and pause electives to control spread, accepting the cost to routine care?
- Harm from the outbreak vs. harm from delayed elective and cancer care.
- How long closure is sustainable and what the exit criteria are.
- Regional knock-on effects if you divert or stop transfers.
D2How transparent are you with patients and the public during an active outbreak?
- Duty of candour vs. reputational and legal caution.
- Staff confidence and retention if disclosure is delayed.
- Consistent messaging across the affected hospitals.
Response playbook
Contain
- Isolate and cohort cases
- Screen contacts and units
- Enhance environmental decontamination
- Restrict high-risk transfers
Sustain care
- Protect essential services
- Define elective pause criteria
- Deploy diagnostic stewardship
- Support and protect staff
Recover & learn
- Confirm outbreak closure
- Restore elective activity
- Feed lessons into IPC policy
- Report to regional/national bodies
After-action questions
- How quickly did you actually detect full resistance, and does that lag change outcomes?
- Was the transfer network a vector you could have anticipated and monitored?
- What is your standing threshold for pausing electives, and who owns that call?
National benchmark references
Real national strategies from the Global Pandemic Preparedness Benchmark that inform this scenario.