This case presents a medical scenario involving a 55-year-old woman in critical condition after a suspected bioterrorism attack involving pneumonic plague. The patient arrives at the emergency department intubated and in septic shock, with a history of severe respiratory distress, high fever, and coughing up blood. EMS reports possible exposure to a plague bioterrorism attack in a subway, raising concerns about the patient’s condition and potential public health risks. The case focuses on recognizing bioterrorism-related illnesses, using appropriate personal protective equipment (PPE), and isolating the patient. Key management steps include advanced airway management, fluid resuscitation, vasopressor support, and initiating appropriate antibiotics for pneumonic plague. The scenario also highlights the need for coordination with infection control, notification of public health authorities, and postexposure prophylaxis for healthcare providers exposed to the patient’s secretions. This exercise emphasizes quick, coordinated care in the face of a potential biological disaster involving a highly contagious pathogen.