Recognizing the need to exercise public health emergency response, and enabled by funding and directives from CDC and HRSA, health departments throughout the US have implemented exercise programs. These exercise programs have had varying goals, including building relationships among stakeholders [7, 8] , training staff [9] [10] [11] , and evaluating preparedness levels [12, 13] , and they have been used for a variety of purposes, including to identify gaps in preparedness [14] , make recommendations for improving preparedness [15] , and identifying variations in preparedness across health departments [16] . These exercises have involved diverse groups of stakeholders involved in public health preparedness, such as representatives from public health [17] , health care [18] , agriculture [19] , and emergency medical services [20] . Despite the commonality of preparedness and response compo-nents across a variety of biological threats, most exercises have been designed for single use and focus on single disease, such as smallpox [21] , pandemic influenza [22] , or a novel virus [23] .