Data for this paper come from four related projects conducted from 2003-2006. Taken together, these projects involved developing, conducting, and evaluating 31 tabletop exercises with state and local health departments of different sizes and structures in 13 different states across the northeast, south, mid-west, and west regions of the country (Table 1) . Participating health departments did not incur any expenses through their involvement in these exercises other than the staff time required to participate.