FORT SHAFTER, Hawaii - It could be a nightmare situation. A 747 jumbo jet originating from a foreign country in the Pacific arrives at Honolulu International Airport.

On board are dozens of sick passengers, complaining of a runny nose, sore throat and general fatigue. The passengers disembark and join the population in Hawaii.

A few hours later, a person checks into the hospital with severe flu-like symptoms. After numerous tests, the hospital receives the results - avian influenza has reached Oahu. From there, the outbreak spreads to the neighboring islands, infecting thousands.

During Exercise Lightning Rescue 08, more than 40 organizations, units and interagency partners came together July 21-25 to prepare and practice for this situation.

Lightning Rescue 08 is a Joint Task Force - Homeland Defense exercise designed to test federal, state and local agencies' coordinated efforts in responding to pandemic influenza or other natural/manmade disasters throughout the Pacific.

It is designed to enhance disaster management authorities' response throughout the Pacific region to a wide range of disasters, specifically pandemic influenza.

This exercise brought together dozens of fire, medical, military and police personnel, all with the goal of stopping the spread of a global epidemic in the United States.

"Our operation is at a level that you won't find elsewhere," said Toby Clairmont, director of the Hawaii Disaster Medical Assistance Team. "Largely, it's because we know that we have to work together."

The scenario kicked off July 22 when an aircraft arrived at the Honolulu International Airport filled with role playing passengers simulating flu-like symptoms. With two hours of lead time, the Hawaii Disaster Medical Assistance Team set up an isolation treatment facility at the Honolulu International Airport, capable of quarantining and treating those with pandemic influenza.

"An isolated treatment facility is intended to provide for moderate to severely injured or ill people under isolated conditions," Clairmont said. "Since we're working with a biological agent, it's important that we limit the chance to spread the influenza. This way, we serve as a buffer to local hospitals."

As the simulation progressed and passengers began to debark the aircraft, medical personnel, dressed in full personal protective equipment including masks, gloves and lab gowns, rushed on board to start the triage process. Those who were feeling sick were assessed and sent to receive medical aid. Those passengers who said they felt fine were sent to a quarantined area and monitored.

According to Clairmont, the scenario was very realistic. More than 50 role players volunteered to act as passengers and each had a back story to aid in the scenario. Some were blind and needed seeing-eye service dogs while others came off the plane playing a drunk passenger.

"The confusion, the questions from the passengers, the service animals they bring with them, all of it is real," he said. "This is the anticipated model of what would happen."

Members of JTF-HD were on hand to observe the exercise in an effort to see how assets of the U.S. military can be mobilized to assist civilian authorities if such a disaster occurs.

"Clearly, we are isolated out here in the middle of the Pacific, probably the most austere island we have to be able to care for ourselves," said Lt. Col. Ed Toy, chief of JTF-HD. "As a community of responders, the military is a stakeholder in the effort. We look at this exercise as an opportunity to see where we may potentially provide capability, when requested, to augment the initial response activities."

He also stressed that JTF-HD always provides support to the on-scene commander, and is never in charge.

JTF-HD has annually conducted Lightning Rescue, continuing to grow from lessons learned from previous exercises. Those lessons learned have been incorporated into this year's exercise, which marks the first time part of the exercise has been held at the Honolulu International Airport.

The scenario continued at the Pacific Missile Range Facility in Kauai July 24. The Federal Emergency Management Agency asked the Department of Defense to set up a "safe haven" after heath care facilities around the island were overwhelmed with sick patients.

According to the scenario, the hospitals in Kauai filled up and sick patients were sent to Kauai Veterans Memorial Hospital where a temporary medical facility was set up outside the hospital's emergency entrance. After DMAT screened them, those who showed minor signs of avian influenza were sent to PMRF for further screening and treatment in a "safe haven" protected area.

The safe haven included medical personnel from Tripler Army Medical Center, Coast Guard, Navy, Air Force, Hawaii state and local emergency services, Department of Homeland Security, FEMA and the Red Cross.

The medical staff continued to assess the "patients," played by more than 30 JROTC cadets from local high schools. Meanwhile, a C-17 "Globemaster II" evacuated two role-playing patients to Oahu to be treated for an acute illness.

"The power of this exercise is that it collectively assigns roles," Toy said. "Everyone has to do their part. We always have to know what the other organizations can do so we can better understand our part and where we fit in."

"Operation Lightning Rescue has been played out many times, but this is the first time we've been at the airport and had this volume of actors," Clairmont added. "At the end of the day, we'll sit down and figure out what we did right and what we did wrong so we can ensure that Hawaii will be as prepared as possible in the case of avian influenza."