When a patient with a suspected high consequence infectious disease (HCID) arrives in Minnesota, preparation must be immediate, precise and seamless. At the center of that readiness is the Special Pathogens Unit (SPU)—one of only 13 federally designated Regional Emerging Special Pathogen Treatment Centers in the United States.
Established following the 2014 Ebola outbreak, these regional centers were created to ensure the country could safely and effectively manage diseases such as Ebola virus disease, Lassa fever and other viral hemorrhagic fevers. Minnesota’s SPU serves a multi-state region across the Upper Midwest, providing specialized care for patients across ASPR Region 5, which includes Minnesota and surrounding Great Lakes states.
While the unit may rarely open its doors to an active HCID patient, its readiness never pauses.
That’s where M Simulation comes in.
Preparing for a rare but critical moment
The clinicians who staff the SPU come from across the hospital: intensive care, emergency medicine, respiratory therapy and more. In their daily roles, they may not routinely work side by side. But in the event of an activation, they must immediately function as a tightly coordinated, highly specialized team.
“The team is assembled almost at a moment’s notice,” says E.B. Floersch, assistant director for M Simulation. “They all work within the hospital, but this work—inside the Special Pathogens Unit—only happens during drills or real activations.”
That level of readiness is made possible through the close, sustained partnership between M Simulation and M Health Fairview—a collaboration that brings simulation-based education directly into the clinical environment where care happens. Together, the teams design and run in-situ simulations that strengthen coordination, communication, and clinical decision-making across multiple pediatric care settings, including the NICU, PICU, Pediatric Emergency Department, and the Special Pathogens Unit. The exercises are immersive and highly realistic. Participants don full protective equipment, including powered air-purifying respirators that cover the head and multiple layers of gowns and gloves, leaving no skin exposed.
A high-fidelity mannequin presents with symptoms consistent with a high consequence infectious disease. The team must assess the patient, communicate clearly, initiate treatment and document care—all while navigating the physical strain and cognitive demands of enhanced PPE.
“It’s one thing to know how to place a central line,” Floersch explains. “It’s another to do it when your dexterity is limited, your hearing is muffled and your cognitive load is significantly higher.”
Over time, the training has evolved. Early sessions focused on practicing discrete tasks in PPE. Today’s simulations examine the entire system of care. Teams test workflows, equipment placement, communication channels and safety protocols. They evaluate how easily supplies can be accessed, whether donning and doffing processes are efficient, and how well team members can coordinate when voices are muffled behind respirators.
The simulations function not only as practice, but as a structured needs assessment for a unit that cannot afford missteps. Small inefficiencies—an awkward equipment layout, an unclear communication pathway—can become magnified in a high-risk environment. Repetition allows teams to refine those details long before a real patient arrives.
“This is a novel application of simulation methodology used for process improvement in the clinical setting to increase safety for patients and also healthcare teams”, says Lou Clark, PhD, MFA, executive director, M Simulation.
Just as importantly, the exercises build shared experience. Because SPU staff are drawn from different departments, simulation creates space to establish role clarity, trust and a common mental model of care. In a scenario where every action must be deliberate, that cohesion is critical.
Readiness as a mission
While M Simulation’s quarterly exercises focus on the patient’s time inside the SPU, Floersch emphasizes that the care journey is much larger.
If a patient in rural Wisconsin presents with symptoms like Ebola, for example, the process may involve local hospital triage, the Centers for Disease Control and Prevention consultation, coordinated air transport—typically via specialized private aircraft—and a structured ground transfer before arrival in Minnesota.
The SPU is one of many critical links in that chain.
“There is an entire transportation and activation process that happens before the patient reaches the regional center,” Floersch explains. “Our simulations focus on the time in the unit, but we recognize that it’s part of a much broader system.”
Together, these efforts reinforce the SPU’s role as a regional safeguard—one that supports not only Minnesota but the broader Upper Midwest.
“We’re preparing for something that we hope never happens,” Floersch says. “But if it does, we want the team to walk in confident, coordinated and ready.”
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