Most local health departments articulated some type of plan for increasing medical surge capacity by developing alternative care sites. In most instances however, these plans were unable to hold up to even a modest amount of scrutiny during the exercise because they were superficial and lacked sufficient detail necessary for rapid implementation. Related to this issue, local health departments frequently reported that there were not enough local health care workers to manage these sites even if they could create them. For example one participant noted, "We have pop-up tents and beds to increase capacity, we just don't have pop-up people to staff them."