the role of local health departments in recognizing and initiating a response to an emergency. The scenarios typically began with a single case report or series of case reports that heralded a nascent disease outbreak and required a public health assessment. These situations exercised the internal communication and coordination across disciplines within health departments as well as the communication and coordination with partner agencies and organizations such as health care facilities and emergency medical service agencies. Several exercises extended beyond this initial response and included scenarios that progressed days or weeks into an outbreak, requiring greater interactions between local-and state-level authorities and attention to health care surge capacity.