One school. Four delegates. Three arenas.

What you do

Asterion Health Alliance serves a metropolitan center and three community hospitals. Its unrestricted capital envelope is $48 million, with a $6 million minimum reserve. Competing investments exceed available funds. A rival provider is capturing profitable outpatient demand, a maternity pathway needs safer transfer capacity, and a cyber infrastructure replacement cannot be delayed indefinitely. A lender wants stability. Clinicians want equipment. Communities want access. The team decides what deserves capital and what it will refuse.

Why this event is Legacy-level

A sequence of locked actions creates consequences. Rival encounters test judgment. Technical and clinical evidence must survive execution. The final hearing examines both what the team chose and how it revised. No slide deck can replace the work history.

Four-person operating model

• Finance strategist: sources and uses, debt, cash flow, and downside cases.
• Clinical access officer: safety floors, service continuity, equity, and transfer feasibility.
• Investment and risk analyst: sensitivities, workforce dependencies, and implementation.
• Negotiation and board lead: partner terms, concessions, public defense, and accountability.

Five-act storyline

Preparation before competition

Study capital budgeting, hospital finance, access and equity, negotiation, and board defense. Eight weeks out, expect a topic, skills blueprint, templates, formula sheet, and allowed-tool list. The complete fictional case releases only at monitored check-in.

At competition

Regional day: 08:00 full case release, 10:00 opening lock, 10:45 first execution and rival encounter, 12:30 consequence inject, 13:30 major reversal, 14:30 final hearing and individual questioning, 15:30 artifact lock. States may split analysis and reversal across two controlled days. No overnight homework or midnight injects.

Required work product

Locked act packets, an assumptions register, numbered evidence citations, a rival term sheet or walk-away, and a final board book that a real organization could follow.

Championship rubric. 1,000 points.

Every Legacy event uses a 1,000-point rubric. For each criterion, a judge awards a 0 to 4 anchor. Awarded points equal the criterion maximum times the level divided by 4. Half-levels need a written rationale. Three judges rate independently, then scores are averaged. Each criterion is scored once over the full evidence trail.

Student success standard

A standout team names what it will not fund, keeps the reserve honest, and can explain every locked act after a reversal. Novelty is not automatically superior.

Annual expansion

The annual health-system type and project set can change. The Sovereign Ledger identity stays: scarce capital, essential care, and public accountability.

Round difficulty

• Regionals. One-day five-act case with a concise evidence packet, one principal rival encounter, and common core injects.
• States. Richer data, tighter constraints, deeper stakeholder conflict, and more developed encounter cycles. Expanded logistics appear in the event notice.
• Nationals. System-level dependencies and harder uncertainty, with the same published criterion weights. Scheduling is approved separately.

Rules and boundaries

• During controlled phases, only supplied materials and authorized tools are allowed. No open internet, generative AI, personal messaging, or outside coaches unless a specific rule authorizes a tool.
• The complete fictional case releases only at monitored check-in. Recommended advance release is a broad topic, skills blueprint, sample templates, formula sheet, and allowed-tool list eight weeks before Regionals.
• Each exhibit carries an ID, timestamp, units, and reliability status. Distinguish confirmed facts, estimates, allegations, and binding constraints. A contradictory actor statement is not automatically true.
• Lock each decision before the next release. Later revisions must identify the changed fact, the old assumption, the new action, and its owner. Correcting an error earns adaptation credit. It does not erase the earlier error from the evidence trail.
• Rival encounters test negotiation, evidence, and composure. Teams earn points for defensible decisions, not simply for beating a weaker opponent. An uncooperative rival cannot deny a team all transaction points.
• All cases are fictional. No patient care, medication administration, real clinical records, unapproved human testing, legal representation, or actual investment solicitation.
• Lock the decision before the next release. Later revisions must identify the changed fact, the old assumption, the new action, and its owner.
• Safety-critical care is never auctioned.
• A team can win without accepting a deal or expanding services if its alternative meets constraints and withstands challenge.

What you do

Meridian Regional is a fictional 320-bed referral hospital. An electronic-record outage coincides with a storm that limits transport and staff arrivals. Emergency demand rises while neighboring hospitals strain. Oxygen, blood, and qualified coverage are finite. Elective procedures support cash flow but compete for capacity. The team must hold the organization together without making unsafe promises.

Why this event is Legacy-level

A sequence of locked actions creates consequences. Rival encounters test judgment. Technical and clinical evidence must survive execution. The final hearing examines both what the team chose and how it revised. No slide deck can replace the work history.

Four-person operating model

• Incident commander: authority, objectives, decision cadence, and logs.
• Clinical continuity lead: service priorities, handoffs, escalation, and transfer safety.
• Workforce and logistics chief: staffed beds, credentials, rest limits, inventory, and transport.
• Finance and public trust lead: spending authority, cash exposure, accurate messages, and board oversight.

Five-act storyline

Preparation before competition

Study incident command, hospital operations, staffing, logistics, downtime workflows, and public communication. The complete incident packet releases at monitored check-in.

At competition

The same one-day five-act Regional clock as the rest of the Triad. Mutual aid is a scored encounter, not a courtesy scene. Restoration without verification fails the relevant criterion.

Required work product

Command chart, service-priority matrix, mutual-aid record, verification criteria, rest plan, and after-action reforms.

Championship rubric. 1,000 points.

Every Legacy event uses a 1,000-point rubric. For each criterion, a judge awards a 0 to 4 anchor. Awarded points equal the criterion maximum times the level divided by 4. Half-levels need a written rationale. Three judges rate independently, then scores are averaged. Each criterion is scored once over the full evidence trail.

Student success standard

A standout team keeps contemporaneous logs, refuses fictitious capacity, and corrects a false all-clear in public. Cooperation may be a winning strategy.

Annual expansion

The annual hazard can change. Nightfall: Code Meridian stays a command event about cascading failure, finite resources, and public trust.

Round difficulty

• Regionals. One-day five-act case with a concise evidence packet, one principal rival encounter, and common core injects.
• States. Richer data, tighter constraints, deeper stakeholder conflict, and more developed encounter cycles. Expanded logistics appear in the event notice.
• Nationals. System-level dependencies and harder uncertainty, with the same published criterion weights. Scheduling is approved separately.

Rules and boundaries

• During controlled phases, only supplied materials and authorized tools are allowed. No open internet, generative AI, personal messaging, or outside coaches unless a specific rule authorizes a tool.
• The complete fictional case releases only at monitored check-in. Recommended advance release is a broad topic, skills blueprint, sample templates, formula sheet, and allowed-tool list eight weeks before Regionals.
• Each exhibit carries an ID, timestamp, units, and reliability status. Distinguish confirmed facts, estimates, allegations, and binding constraints. A contradictory actor statement is not automatically true.
• Lock each decision before the next release. Later revisions must identify the changed fact, the old assumption, the new action, and its owner. Correcting an error earns adaptation credit. It does not erase the earlier error from the evidence trail.
• Rival encounters test negotiation, evidence, and composure. Teams earn points for defensible decisions, not simply for beating a weaker opponent. An uncooperative rival cannot deny a team all transaction points.
• All cases are fictional. No patient care, medication administration, real clinical records, unapproved human testing, legal representation, or actual investment solicitation.
• Lock the decision before the next release. Later revisions must identify the changed fact, the old assumption, the new action, and its owner.
• Do not punish appropriate medical mutual aid.
• Unsafe proposals affect the safety criterion. An honest analytical mistake is not automatic disqualification.

What you do

A fictional hospital consortium is considering JANUS, an AI deterioration-prediction and care-routing platform. Aggregate performance looks compelling and projected savings are large. Local data are fragmented. Subgroup estimates are uncertain. The contract restricts audit access. A competing product offers less automation but better integration. The team must distinguish an impressive demo from an accountable clinical system.

Why this event is Legacy-level

A sequence of locked actions creates consequences. Rival encounters test judgment. Technical and clinical evidence must survive execution. The final hearing examines both what the team chose and how it revised. No slide deck can replace the work history.

Four-person operating model

• Clinical validation lead: outcome relevance, error consequences, and the safety case.
• Data and technical lead: denominators, missingness, leakage, calibration, and local validity.
• Governance and security lead: privacy, audit access, incident ownership, and shutdown authority.
• Implementation and finance lead: workflow, total cost, procurement, staffing, and alternatives.

Five-act storyline

Preparation before competition

Study clinical validation, diagnostic-performance concepts, bias, privacy, procurement, and workflow design. The complete JANUS dossier releases at monitored check-in.

At competition

The same one-day five-act Regional clock. Rejection can score at the highest level if the record supports it. A red-team challenge is scored independently. No point stealing.

Required work product

Evidence audit, procurement memo, recomputed metrics, incident reconstruction, and a kill-switch safety case.

Championship rubric. 1,000 points.

Every Legacy event uses a 1,000-point rubric. For each criterion, a judge awards a 0 to 4 anchor. Awarded points equal the criterion maximum times the level divided by 4. Half-levels need a written rationale. Three judges rate independently, then scores are averaged. Each criterion is scored once over the full evidence trail.

Student success standard

A standout team treats accuracy as insufficient, names uncertainty, and can shut the system down with a real owner. Marketing is not evidence.

Annual expansion

The annual product class can change. The Janus Protocol stays an accountable-innovation event: validate, contract, reverse, and defend a kill switch.

Round difficulty

• Regionals. One-day five-act case with a concise evidence packet, one principal rival encounter, and common core injects.
• States. Richer data, tighter constraints, deeper stakeholder conflict, and more developed encounter cycles. Expanded logistics appear in the event notice.
• Nationals. System-level dependencies and harder uncertainty, with the same published criterion weights. Scheduling is approved separately.

Rules and boundaries

• During controlled phases, only supplied materials and authorized tools are allowed. No open internet, generative AI, personal messaging, or outside coaches unless a specific rule authorizes a tool.
• The complete fictional case releases only at monitored check-in. Recommended advance release is a broad topic, skills blueprint, sample templates, formula sheet, and allowed-tool list eight weeks before Regionals.
• Each exhibit carries an ID, timestamp, units, and reliability status. Distinguish confirmed facts, estimates, allegations, and binding constraints. A contradictory actor statement is not automatically true.
• Lock each decision before the next release. Later revisions must identify the changed fact, the old assumption, the new action, and its owner. Correcting an error earns adaptation credit. It does not erase the earlier error from the evidence trail.
• Rival encounters test negotiation, evidence, and composure. Teams earn points for defensible decisions, not simply for beating a weaker opponent. An uncooperative rival cannot deny a team all transaction points.
• All cases are fictional. No patient care, medication administration, real clinical records, unapproved human testing, legal representation, or actual investment solicitation.
• Lock the decision before the next release. Later revisions must identify the changed fact, the old assumption, the new action, and its owner.
• A recommendation to reject technology can score at the highest level if the case evidence supports it.
• Judges reward teams that recognize when workforce or process redesign is better than automation.