As outbreaks evolved, there was often a lack of clarity about whether and when local health departments should hand off control to the state health department, how responsibilities should be jointly shared between local and state authorities, and whether or when federal agencies, such as CDC, should become involved. In many of the exercises, state health departments were surprised by the level of assistance requested by their local health departments especially in the early stages of the outbreak; in other more rare examples, state health departments surprised local health departments by assuming roles and responsibilities local health departments regarded as their own. Regardless, the general consensus among local public health participants in most exercises was that CDC staff would be on the ground to help them fairly quickly, particularly in situations where bioterrorism was considered likely.