This report was developed by the Office of Public Health Preparedness and Response (OPHPR),

Centers for Disease Control and Prevention (CDC) 

Rear Admiral Ali S. Khan, MD, MPH

Director and Assistant Surgeon General

Daniel M. Sosin, MD, MPH, FACP

Deputy Director and Chief Medical Officer

Ann O’Connor, MPA

Associate Director for Policy

Project Team

Stacey Bloomer Brawner, MS

Denise Casey

Brian Rutter, MBA 

Monique Salter, MPH

Laurie Schnepf

Mina Zadeh, PhD

CDC Analytical and Data Support

OPHPR, Division of State and Local Readiness

Craig W. Thomas, PhD; Rich Ann Baetz, MSCRP; Michael Fanning, MPH

OPHPR, Division of Strategic National Stockpile 

Linda Neff, PhD; Jaime Jones, MPH

Program Service Consultants (see inside back cover)

Office of Infectious Diseases,

National Center for Emerging and Zoonotic Infectious Diseases 

Laura Jevitt, MPH; Jasmine Chaitram, MPH

Office of Noncommunicable Diseases, Injury and Environmental Health,

National Center for Environmental Health/Agency for Toxic Substances and Disease Registry

Robert Kobelski, PhD; Rachael Schmidt, MPH

Other CDC Contributors

Office for State, Tribal, Local and Territorial Support 

Office of Infectious Diseases 

Office of Noncommunicable Diseases, Injury and Environmental Health 

Office of Surveillance, Epidemiology, and Laboratory Services 

Subject Matter Experts Across CDC

Special Thanks

Association of Public Health Laboratories

Association of Schools of Public Health

Association of State and Territorial Health Officials

Council of State and Territorial Epidemiologists

National Association of County and City Health Officials

Report available at emergency.cdc.gov/publications/2010phprep

For more information on CDC’s preparedness and emergency response activities, visit the website of the Office of 

Public Health Preparedness and Response at emergency.cdc.gov/cdcpreparedness

CS215921-A
Dedication

This report is 

dedicated to the 

memory of Diane 

Berry Caves, who 

lost her life during 

the January 12, 

2010 earthquake 

in Haiti while on a 

3-week assignment 

to improve Haitian 

HIV/AIDS programs. 

A dedicated public 

health professional, Diane led the development of 

the first CDC report on public health preparedness, lauded by many as innovative, and played 

integral roles in the strategic development of 

the two succeeding reports. These reports 

demonstrate accountability and drive program 

improvement for public health preparedness 

and response. 

In acknowledgement of her sacrifice, Diane was 

posthumously awarded the U.S. Department of 

State Thomas Jefferson Star for Foreign Service. 

This award recognizes people seriously injured or 

killed while traveling or serving abroad on official 

business. The award was signed by President 

Obama and bestowed by Secretary of State Clinton 

at a Memorial Ceremony in May 2010. CDC 

planted a Glory Maple tree in Diane’s honor at its 

headquarters in Atlanta, GA.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 1

Public Health Preparedness:

Strengthening the Nation’s 

Emergency Response State by State

A Report on CDC-funded Preparedness and Response Activities 

in 50 States, 4 Cities, and 8 U.S. Insular Areas

Table of Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Protecting the Nation from Public Health Threats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Preparedness and Response Efforts Require Work at All Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Funding Supporting Public Health Preparedness and Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Measuring Preparedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

About This Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Public Health in Action: Responding to Emergencies Across the Nation . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Section 1: A National Snapshot of Public Health Preparedness Activities

Surveillance and Epidemiology: Monitoring and Investigating Health Threats . . . . . . . . . . . . . . . . . . . . . . 17

Laboratories: Identifying and Understanding Emerging Public Health Threats . . . . . . . . . . . . . . . . . . . . . . 21

Response Readiness: Communicating, Planning, Exercising, and Evaluating . . . . . . . . . . . . . . . . . . . . . . . . 27

Additional CDC Resources Supporting Preparedness in States and Localities . . . . . . . . . . . . . . . . . . . . . . . 35

Moving Forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Section 2: Public Health Preparedness and Response Activities in States, Localities, and U.S. Insular Areas 

Fact Sheets for 50 States and the 4 Localities of Chicago, 

the District of Columbia, Los Angeles County, and New York City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Overview of Preparedness in the U.S. Insular Areas: Territories, 

Commonwealths, and Freely Associated States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

Appendices

Appendix 1: Explanation of Fact Sheet Data Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Appendix 2: Overview of CDC Organizations Involved in Preparedness Activities . . . . . . . . . . . . . . . . . . . 167

Appendix 3: Terrorism Preparedness and Emergency Response Funding . . . . . . . . . . . . . . . . . . . . . . . . . 171

Appendix 4: Public Health Emergency Preparedness Cooperative Agreement Funding . . . . . . . . . . . . . 172

Appendix 5: Public Health Emergency Response Grant Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Appendix 6: Cities Readiness Initiative Technical Assistance Review Scores for 2007-2008 . . . . . . . . . . 178

Appendix 7: Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

Page
2 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Preface

Public Health Preparedness: Strengthening the Nation’s Emergency Response State 

by State presents data on preparedness 

activities taking place at state and local health 

departments in 50 states, 4 localities (Chicago, 

the District of Columbia, Los Angeles County, 

and New York City), and 8 U.S. insular areas 

located in the Atlantic and Pacific oceans.1

All are funded by the Centers for Disease 

Control and Prevention’s (CDC) Public Health 

Emergency Preparedness (PHEP) cooperative 

agreement.

Reports on public health preparedness are 

an important part of CDC’s overall focus 

on demonstrating results, driving program 

improvements, and increasing accountability 

for the nation’s investment in public health 

preparedness. CDC has now released 

three preparedness reports; this is CDC’s 

second report with state-by-state data on 

preparedness activities. It includes updates 

(when available) to data presented in CDC’s 

first state preparedness report, Public Health 

Preparedness: Mobilizing State by State 

(2008),

2

 as well as new data on state and local 

preparedness activities. In 2009, Congress 

expressed its desire for CDC to continue to 

report state-by-state data.3

Section 1 of this report focuses on core public 

health functions and provides national-level 

data on preparedness activities in laboratories 

and response readiness. Section 2 includes 

54 data fact sheets for each of the 50 states 

and 4 localities, followed by a description of 

preparedness progress and challenges in the 8 

U.S. insular areas. 

Also included in this report are snapshots of 

preparedness and response activities and 

accomplishments occurring during the 2009 

H1N1 influenza pandemic. Activities conducted 

in 2008 and 2009, the primary timeframes 

for data in this report, helped build and 

Preface

strengthen capabilities in the states and at 

CDC that were essential for responding to the 

pandemic. 

All reported activities were supported by 

CDC’s Terrorism Preparedness and Emergency 

Response funding (which includes PHEP). This 

report does not describe all preparedness 

activities conducted at CDC or in states and 

localities. For a description of the broader 

range of CDC preparedness and response 

activities, see CDC’s second preparedness 

report, Public Health Preparedness: 

Strengthening CDC’s Emergency Response 

(2009)

4

 

How Different Audiences Can Use 

This Report 

This report was written for a variety of 

audiences. States and localities can use this 

information to broaden their knowledge about 

progress and gaps in preparedness across their 

jurisdictions and throughout the nation. 

Congress and other policymakers can gauge 

national public health preparedness as they 

read about many of the activities that states, 

localities, and insular areas have undertaken to 

improve public health preparedness.

Other federal departments and agencies 

and CDC partners (e.g., key public health 

associations) may gain a greater understanding 

of the scope of federally funded preparedness 

activities. This may help to generate new ideas 

for collaboration. 

Within CDC, programs can use the report 

to gain a broader understanding of how 

states, localities, and U.S. insular areas are 

preparing for public health emergencies, their 

capabilities and gaps, and the challenges they 

face. This information can also be used as a 

tool to guide CDC’s technical assistance to 

recipients of PHEP funds. 

Reports on public 

health preparedness 

are an important part 

of CDC’s overall focus 

on demonstrating 

results, driving program 

improvements, and 

increasing accountability 

for the nation’s 

investment in public 

health preparedness.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 3Executive Summary

Public health threats are always present. They include natural disasters; biological, 

chemical, and radiological incidents; and 

explosions. The impact of these threats can 

range from local outbreaks to incidents with 

national or global ramifications. The 2009 

H1N1 influenza pandemic underscored the 

importance of communities being prepared 

for potential threats. Being prepared to 

prevent, respond to, and rapidly recover from 

public health threats can protect the health 

and safety of the public and emergency 

responders. 

Public health preparedness is ongoing.

Preparing adequately for public health 

emergencies requires continual and 

coordinated efforts that involve every level 

of government, the private sector, nongovernmental organizations, and individuals. 

The Centers for Disease Control and 

Prevention (CDC) plays a pivotal role in efforts 

to prepare our nation for all types of public 

health threats.5

CDC’s mission is to collaborate to create 

the expertise, information, and tools that 

people and communities need to protect 

their health. CDC seeks to accomplish this 

mission in preparedness by building and 

strengthening capabilities that can be used 

broadly for all types of hazards and tailored 

to particular incidents. Critical core public 

health capabilities include surveillance 

and epidemiology, laboratories, and 

response readiness activities that include 

communicating, planning, exercising, and 

evaluating.

CDC support to states, localities, and U.S. 

insular areas.6 CDC works with public health 

departments by providing funding, technical 

assistance, and coordination of activities for 

responding to public health threats. For severe 

emergencies, states, localities, and U.S. insular 

areas can request additional public health 

resources from CDC to assist with a response.

Preparedness funding. Congress has 

supported CDC public health preparedness 

and response activities by appropriating 

approximately $1.5 billion per year since 2002. 

CDC’s Office of Public Health Preparedness and 

Response (OPHPR; formerly the Coordinating 

Office for Terrorism Preparedness and 

Emergency Response)7 manages these funds, 

which support a wide variety of activities at 

CDC and at state and local levels. Congress 

appropriates three-quarters of this funding for 

two programs, the Public Health Emergency 

Preparedness (PHEP) cooperative agreement 

and the Strategic National Stockpile. OPHPR 

allocates the remainder of the funding 

to preparedness programs across CDC. In 

2009, Congress also provided emergency 

supplemental funding in response to the 2009 

H1N1 influenza pandemic.

Reporting on preparedness. To demonstrate 

how these federal investments are improving 

the nation’s ability to respond to public 

health emergencies, CDC has published 

three preparedness reports.8 This is CDC’s 

second report focusing on state preparedness 

activities, including capability-based 

performance measures for states and localities 

receiving PHEP funding. Fact sheets in this 

report cover activities occurring primarily from 

October 1, 2007 to September 30, 2008 (fiscal 

year 2008). In addition, some data from 2009 

are included. 

Executive Summary

The Centers for Disease 

Control and Prevention 

plays a pivotal role in 

efforts to prepare our 

nation for all types of 

public health threats.

States, localities, and U.S. insular 

areas received supplemental 

funding to prepare for and 

respond to the 2009 H1N1 

influenza pandemic. Funds 

were used to assess response 

capabilities and address remaining 

gaps in vaccination; antiviral drug 

distribution and dispensing; and 

laboratory, epidemiology, and 

surveillance activities. 

Photo source: Boston Public Health 

Commission
4 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Executive Summary

While these data do not represent all 

preparedness activities occurring in states, 

localities, and U.S. insular areas, they 

significantly expand on the information 

provided in CDC’s first state preparedness 

report published in 2008.9 All three CDC 

reports provide the most comprehensive 

picture available on the breadth of public 

health preparedness and response efforts 

across the nation.10

Strengthening Preparedness 

Much progress has been made to build 

and strengthen national public health 

preparedness and response capabilities. 

Accomplishments highlighted in this report 

include the following:

• Biological laboratory capabilities and 

capacities were strong in most states 

and localities. Most laboratories in the 

Laboratory Response Network (LRN) could 

be reached 24/7, rapidly identified certain 

disease-causing bacteria and sent reports 

to CDC, and passed proficiency tests for 

detecting other biological agents. (See 

Table 3 on page 26.)

• A majority of LRN chemical laboratories 

demonstrated proficiency in core methods 

for detecting and measuring exposure 

to chemical agents, and some were 

proficient in one or more additional 

methods identified by CDC as important for 

responding to chemical emergencies. (See 

Table 3 on page 26.)

• All states and localities could receive urgent 

disease reports 24/7, and most states used 

rapid methods to communicate with other 

laboratories for outbreaks, routine updates, 

and other needs. (See Table 8 on page 34.)

• All states received acceptable CDC review 

scores for their plans to receive, distribute, 

and dispense medical assets from CDC’s 

Strategic National Stockpile and other 

sources. (See 2008-2009 data in Table 8 on 

page 34.)

• Most states and localities demonstrated 

the ability to activate and rapidly staff their 

emergency operations centers for drills, 

exercises, or real incidents, and developed 

after action reports and improvement plans 

following these activities. (See Table 8 on 

page 34.)

Moving Forward

CDC has identified the areas listed below for 

improving state and local preparedness.

Maintain preparedness gains and resolve 

gaps. Important gains have been made 

since CDC’s 2008 state preparedness report 

in the areas of laboratory and response 

readiness. Data presented in this report 

show improvement in rapid laboratory 

testing for biological agents and readiness to 

receive, distribute, and dispense assets from 

CDC’s Strategic National Stockpile. CDC will 

continue to work with state and local health 

departments to maintain these improvements 

and to identify and resolve gaps in these 

and other core capabilities important for 

preparedness and response. Improvements are 

needed in continuity of operations plans for 

state public health laboratories.

CDC manages the 

Laboratory Response 

Network, a group of 

local, state, federal, 

and international 

laboratories that 

can detect and 

characterize 

health threats. 

Photo source: CDC
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 5Executive Summary

Build on the successes and lessons learned 

from the response to the 2009 H1N1 influenza 

pandemic. The first influenza pandemic in 

40 years provided a real world test of our 

response capabilities. CDC is working with all 

levels and sectors of the public health and 

medical communities toward systematically 

assessing this response, developing plans to 

address identified gaps and challenges, and 

incorporating needed changes. 

Ensure continuous funding to build and 

maintain a skilled state and local public health 

workforce. The surge in effort needed to 

respond to the 2009 H1N1 influenza pandemic 

placed an increased strain on a system already 

weakened by workforce shortages and budget 

shortfalls. The response revealed that the 

combination of the continued erosion of the 

general all hazards preparedness capacities, 

infrastructure, and staffing, along with the 

fiscal issues facing state and local governments 

proved to be challenging for public health 

departments. Preparing adequately for 

future outbreaks – and other public health 

emergencies that are inevitable and may 

occur simultaneously – requires predictable 

and adequate long-term funding to improve 

infrastructure, staffing, and training in 

the areas of surveillance, epidemiology, 

laboratories, and response readiness.

Expand performance measurement to 

assess and monitor preparedness activities 

and to drive program improvement and 

accountability. CDC will continue to work 

with state and local partners to develop 

performance measures that are indicators of 

preparedness and response capabilities and 

align with the objectives of the National Health 

Security Strategy11 as well as the Pandemic 

and All-Hazards Preparedness Act.12 Major 

gaps exist for measuring preparedness in the 

areas of surveillance and epidemiology. New 

performance measures are being piloted for 

these areas as well as for laboratory activities. 

Promote health and prevent disease, injury, 

and disability in communities. Healthy 

populations are more resilient to new health 

threats. State and local health departments 

must continue to strengthen their 

collaboration with individuals, families, and 

communities as essential partners in building 

resilience to all types of public health hazards. 

Building healthier communities also helps 

provide greater protection to populations who 

are more vulnerable during emergencies and 

supports broader CDC health protection goals 

and national health reform efforts. 

All 62 PHEP-funded 

states, localities and U.S. 

insular areas have plans 

to receive, distribute, 

and dispense medical 

assets from CDC’s 

Strategic National 

Stockpile and 

other sources. 

Photo source: Indiana State 

Department of Health
6 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State

Protecting the Nation from Public Health Threats

Who is responsible for responding to 

public health emergencies? 

All response begins at the local level. State and 

local health departments are first responders 

for public health emergencies, regardless of 

whether they are local outbreaks or incidents 

with global ramifications, such as pandemics. 

Since 1999, CDC’s Public Health Emergency 

Preparedness cooperative agreement has 

helped build and strengthen state and local 

capabilities that help ensure an effective 

emergency response, but significant challenges 

remain. Core public health functions needed 

for preparedness and response include 

surveillance, epidemiology, laboratories, and 

response readiness.

Individuals, families, and communities are 

essential partners for building community 

resilience to public health hazards. Community 

resilience is a goal of the National Health 

Security Strategy published in December 

2009.14 A resilient community has the sustained 

ability to withstand and recover – in both the 

short and long term – from adversity, such 

as an influenza pandemic or terrorist attack.15

Vulnerable populations16 and those with 

chronic conditions, such as asthma and obesity, 

may require additional care during emergencies 

such as specialized medications, equipment, 

and other assistance. 

Whether caused by natural, accidental, or intentional means, public health threats are 

always present. Being prepared to prevent, respond 

to, and recover rapidly from these events can save 

lives and protect the health and safety of the public, 

including emergency responders.

What are public health threats? 

Biological threats can be natural, accidental, or 

deliberate. They include viruses, bacteria, parasites, 

and fungi (or their toxins) that can cause illness or 

death in people, animals, or plants, and are spread 

through air, water, or food.

Natural disasters include extended heat 

waves, severe snow or ice storms, earthquakes, 

catastrophic hurricanes, and extensive floods. 

Other environmental threats include exposure 

to chemicals that pose carcinogenic, reproductive, 

developmental, and neurological risks.

Chemical and radiological materials released 

accidentally or intentionally could create large-scale 

public health emergencies, especially in densely 

populated areas.

Explosions – by far the most common cause of 

casualties associated with terrorism13 – can result in 

large numbers of casualties with complex injuries 

not commonly seen after natural disasters such as 

floods or hurricanes.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 7Background

Public health threats are always present. They include natural disasters; biological, 

chemical, and radiological incidents; and 

explosions. The impact of these threats 

can range from local outbreaks to incidents 

with national or global ramifications. The 

2009 H1N1 influenza pandemic underscored 

the importance of communities preparing 

for potential threats to the public’s health. 

Being prepared to prevent, respond to, and 

rapidly recover from public health threats can 

protect the health and safety of the public 

and emergency responders. The Centers for 

Disease Control and Prevention (CDC) plays 

a pivotal role in preparing our nation for all 

types of public health threats.17

This report was developed as the nation 

was responding to the 2009 H1N1 influenza 

pandemic. Preparedness activities conducted 

in 2008 and 2009, the primary timeframes 

reflected in this report, helped strengthen 

state and CDC capabilities for responding to 

the outbreak and increased the resiliency of 

communities across the nation. Text boxes 

on state and local response to the pandemic 

appear throughout this report. 

Background

“ Preparedness continues to be a core focus for CDC. The best approach to preparedness is 

the best approach for public health – identify the problems you can do something about, 

develop and implement programs, rigorously evaluate their effectiveness, and look for ways 

to improve them. “ - Thomas Frieden, MD, MPH

 CDC Director

Pandemic Planning Helps States Respond Rapidly 

to the 2009 H1N1 Influenza Pandemic

In April 2009, CDC and the public health workforce faced the first influenza pandemic 

in 40 years. As the initial cases of H1N1 influenza began to emerge in the United States, 

local, state, and federal public health entities quickly took measures to understand the 

patterns of the illness, slow its spread, and mitigate its effects. 

States began to implement their pandemic plans as the number of 2009 H1N1 

influenza cases increased throughout the spring in the United States, Mexico, and other 

countries. At the time, its course was far from certain, with the possibility of multiple 

waves of outbreaks throughout the fall and winter.

Federal investments in pandemic planning (see page 11) helped states lessen 

the impact of the pandemic through increased disease monitoring, ongoing 

communication updates to keep the public informed, more effective use of 

existing resources, appropriate use of mitigation measures, implementation of 

H1N1 vaccination campaigns, and coordination of response efforts with new and 

established partners nationwide and in other countries. Also critically important were 

the expansion of state laboratory capabilities for detecting and confirming the virus, 

and, when necessary, activation of processes for states and localities to receive medical 

supplies such as antiviral drugs and respirators from CDC’s Strategic National Stockpile. 

Pandemic planning also allowed time for thoughtful deliberation and identification 

of challenging decision points, all of which supported accelerated decision making 

during real events. 

H1N1
8 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Background

Many lessons from the 2009 H1N1 influenza 

pandemic are being identified. An overarching 

lesson is the need for a sustained commitment 

to continued planning, training, and exercising 

to help ensure rapid and effective responses 

to future challenges that may threaten the 

public’s health. 

Preparedness and Response Efforts 

Require Work at All Levels

While response begins at the local level, public 

health preparedness requires a coordinated 

effort involving every level of government, 

the private sector, non-governmental 

organizations, and individuals. Being prepared 

to prevent, respond to, and recover from all 

types of public health threats requires that 

states improve their capabilities in the core 

public health functions of surveillance and 

epidemiology, laboratories, and response 

readiness. 

Federal response to public health 

emergencies. Lead federal responsibility 

for emergency response lies with the U.S. 

Department of Homeland Security (DHS), 

whose National Response Framework 

established a single, comprehensive structure 

for responding to all types of hazards.18 In 

addition, the DHS National Preparedness 

Guidelines provide the vision, capabilities, and 

priorities for national preparedness. 

Under the National Response Framework, 

the U.S. Department of Health and Human 

Services (HHS) coordinates federal assistance 

supplementing state, tribal, and local 

resources in response to public health and 

medical disasters.19 The Assistant Secretary 

for Preparedness and Response (ASPR) is the 

principal advisor to the HHS Secretary on all 

matters related to bioterrorism and other 

public health emergencies. ASPR works with 

other federal departments and agencies 

and is charged with the overall coordination 

and oversight of emergency preparedness 

and response activities within HHS. ASPR 

responsibilities include the coordination of 

public health response activities related to 

CDC, which is an operating division of HHS. 

Response to public 

health emergencies 

begins at the local 

level. Pictured is an 

H1N1 vaccination 

clinic in Calistoga, 

California. Federal 

investments in 

pandemic planning 

helped states lessen 

the impact of the 

pandemic. 

Photo source: 

California Department 

of Public Health
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 9Background

CDC is working collaboratively to implement 

the National Health Security Strategy (NHSS).20

The NHSS is a comprehensive strategy 

established to galvanize efforts to minimize 

the health consequences associated with 

significant health incidents. National health 

security is a state in which the nation and 

its people are prepared for, protected from, 

and resilient in the face of health threats 

or incidents with potentially negative 

health consequences. The NHSS’ vision for 

health security is based on a foundation of 

community resilience – healthy individuals, 

families, and communities with access to 

health care and with the knowledge and 

resources to know what to do to care for 

themselves and others in both routine 

and emergency situations. The vision also 

emphasizes strong and sustainable public 

health, health care, and emergency response 

systems. 

CDC mission and preparedness. CDC’s mission 

is to collaborate to create the expertise, 

information, and tools that people and 

communities need to protect their health. 

CDC seeks to accomplish this mission in 

preparedness by building and strengthening 

capabilities that can be used broadly for all 

types of hazards, whether they are biological 

agents, natural disasters, environmental 

exposures, chemical and radiological materials, 

or explosions. In addition, CDC develops 

capabilities that are tailored to particular 

hazardous incidents. 

Public Health Preparedness

The capability of the public health system, 

communities, and individuals to prevent, 

protect against, quickly respond to, and 

recover from health emergencies, particularly 

those in which scale, timing, or unpredictability 

threatens to overwhelm routine capabilities.21

CDC support to states, localities, and U.S. 

insular areas. CDC also works with state, 

local, and U.S. insular area public health 

departments by providing funding, technical 

assistance, and coordination of activities for 

responding to public health threats. For severe 

emergencies, states, localities, and U.S. insular 

areas22 can request additional public health 

resources from CDC to assist with a response. 

To examine how this federal investment is 

improving the nation’s ability to respond to 

public health emergencies, CDC has been 

developing and implementing capability-based 

performance measures. The passage of the 

Pandemic and All-Hazards Preparedness Act 

(PAHPA, 2006)23 by Congress highlighted the 

Photo source: CDC

CDC’s mission is 

to collaborate to 

create the expertise, 

information, and 

tools that people and 

communities need to 

protect their health. 
10 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Background

importance of CDC’s work in developing such 

metrics. PAHPA requires the development of 

measurable preparedness benchmarks and 

objective standards for recipients of CDC 

Public Health Emergency Preparedness (PHEP) 

cooperative agreement funding. Funding to 

state and local agencies was linked to their 

performance in these standards beginning in 

fiscal year (FY) 2009.24 (For more information 

on performance measures, see page 12.) 

Partnering to improve emergency response. 

CDC and public health departments work with 

multiple partners from a variety of sectors. 

Key partners include the American Red Cross, 

Association of Public Health Laboratories, 

Association of Schools of Public Health, 

Association of State and Territorial Health 

Officials, Council of State and Territorial 

Epidemiologists, National Association of 

County and City Health Officials, and National 

Emergency Management Association. These 

organizations share promising practices, 

conduct research, and provide training 

to public health professionals to improve 

preparedness and emergency response.

Funding Supporting Public Health 

Preparedness and Response

Congress has supported CDC public health 

preparedness and response activities by 

appropriating approximately $1.5 billion per 

year since 2002. This Terrorism Preparedness 

and Emergency Response funding supports a 

wide variety of activities at CDC and at state 

and local levels. 

CDC’s Office of Public Health Preparedness and 

Response (OPHPR; formerly the Coordinating 

Office for Terrorism Preparedness and 

Emergency Response)25 is responsible for 

managing these funds. Congress appropriates 

over three-quarters of this funding for 

two CDC programs, the PHEP cooperative 

agreement and the Strategic National 

Stockpile. OPHPR allocates the remainder of 

this funding to preparedness programs across 

CDC. (See appendices 3 and 4 for more details 

on funding levels.)

Congress has also provided emergency 

supplemental funding to address preparedness 

needs related to specific health threats such as 

pandemic influenza.

PHEP cooperative agreement. CDC’s PHEP 

cooperative agreement funds 62 state, 

locality, and U.S. insular area public health 

departments to build and strengthen their 

abilities to respond effectively to public health 

emergencies.26 PHEP funding has declined 

from $970 million in FY 2003 to $689 million 

in FY 2009. (See box below and appendix 4 for 

historical PHEP funding levels.) 

PHEP-funded emergency preparedness 

and response efforts support the National 

Response Framework and are targeted 

specifically for the development of emergencyready public health departments that are 

flexible and adaptable. The Division of State 

and Local Readiness within OPHPR manages 

the PHEP cooperative agreement, provides 

direction on preparedness activities, and 

coordinates technical assistance. 

Included in the PHEP cooperative agreement 

funding is support for the Cities Readiness 

Initiative of CDC’s Strategic National 

Stockpile. This program focuses on enhancing 

$970*

$689 

0

$200 

$400 

$600 

$800 

$1,000 

2002 2003 2004 2005 2006 2007 2008 2009

Millions of dollars

Fiscal year

Public Health Emergency Preparedness 

Cooperative Agreement Funding

PHEP funding has declined from $970 million in 

FY 2003 to $689 million in FY 2009.

*Includes $100 million Smallpox Supplement

Source: HHS and CDC

CDC’s PHEP 

cooperative 

agreement funds 

62 state, locality, 

and U.S. insular 

area public health 

departments 

to build and 

strengthen their 

abilities to respond 

effectively to public 

health emergencies.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 11 Background

preparedness for responding to a largescale bioterrorist event within 48 hours in 

the nation’s largest cities and metropolitan 

statistical areas, where more than half of the 

U.S. population resides.27

Strategic National Stockpile. CDC’s Strategic 

National Stockpile is a national repository 

of critical medical supplies designed to 

supplement state and local public health 

departments in the event of a large-scale 

public health emergency. Funds are also used 

to support technical assistance at state and 

local levels to receive, distribute, and dispense 

the supplies. Stockpile assets help ensure that 

key medical supplies are available to prepare 

for and respond to emergencies. Stockpile 

funding averaged approximately $495 million 

for FY 2002-2009. (See appendix 3 for Stockpile 

funding levels.)

Additional funding for pandemic influenza. 

Recognizing the need to prepare for a possible 

influenza pandemic, Congress appropriated 

two other sources of funding specifically for 

pandemic influenza preparedness activities. 

Beginning in 2005 and continuing through 

2008, CDC awarded approximately $524 

million in Pandemic Influenza Supplement 

funds to the 62 PHEP-funded states, localities, 

and U.S. insular areas for program operations 

to prepare for and respond to an influenza 

pandemic. (See appendix 4 for Pandemic 

Influenza Supplement funding levels.)

Subsequently, as the nation faced the 2009 

H1N1 influenza pandemic, Congress provided 

funding through the 2009 Supplemental 

Appropriations Act28 for the Public Health and 

Social Services Emergency Fund to prepare for 

and respond to an influenza pandemic. Since 

July 2009, CDC has administered $1.4 billion 

from this fund through the Public Health 

Emergency Response (PHER) grant specifically 

for the 2009 H1N1 pandemic influenza 

response. (See appendix 5 for PHER funding 

levels.) PHER funds were used for assessing 

response capabilities and addressing remaining 

gaps in vaccination; antiviral drug distribution/

dispensing; and laboratory, epidemiology, 

and surveillance activities. Funds were also 

used to provide additional resources for mass 

vaccination planning and implementation, and 

to support the implementation of 2009 H1N1 

vaccination campaign.

Cutbacks in state public health investments.

The 2008-2009 economic crisis had a negative 

impact on state investments in public health 

programs. As states faced sharp downturns in 

tax revenues, many cut budgets and reduced 

services, including those affecting the public 

health system. A survey of 57 state and 

U.S. insular area health agencies conducted 

Supplemental funding was 

used to provide additional 

resources for mass vaccination 

planning and implementation, 

and to support the 

2009 H1N1 vaccination 

campaign. Pictured is an 

H1N1 vaccination clinic in 

Cambridge, Massachusetts. 

Photo source: Cambridge Public 

Health Department
12 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Background

by the Association of State and Territorial 

Health Officials reported that 76% of health 

departments made cuts to the FY 2009 budget 

and 61% reported FY 2010 budgets smaller 

than FY 2009.29 Nationwide, a 2010 survey of 

local health departments conducted by the 

National Association of County and City Health 

Officials reported that between January 2008 

and December 2009 health departments lost 

23,000 jobs to layoffs and attrition, roughly 

15% of their entire workforce. In 2009, an 

additional 25,000 local health department 

employees were subjected to reduced hours 

or mandatory furloughs.30 These cutbacks have 

significant implications for public health and 

preparedness. 

Measuring Preparedness

CDC has developed and continues to design 

additional capability-based performance 

measures to monitor how well federal 

investments have improved the nation’s 

ability to prepare for and respond to public 

health emergencies. This report presents 

2008 data (the most current available) on the 

performance measures listed below. The data 

were submitted to CDC by state, locality, and 

U.S. insular area public health departments 

that received PHEP cooperative agreement 

funding. 

Laboratory testing performance measure.

States must be able to detect and determine 

the extent and scope of potential outbreaks 

to minimize their impact. The intent of the 

laboratory testing performance measure 

is to determine if a laboratory can rapidly 

receive, test, and report disease-causing 

bacteria (Escherichia coli O157:H7 and Listeria 

monocytogenes) within a specified timeframe.

Response performance measure. A state, 

locality, or U.S. insular area’s emergency 

operations center serves as the central 

command and control facility for carrying 

out strategic preparedness, planning, and 

management of emergency situations, 

including ensuring continuity of operations. 

The intent of the response performance 

measures is to demonstrate capabilities for 

response activities related to the following 

areas: 

• Notification of emergency operations 

center staff

• Activation of the emergency operations 

center

• Assessment of response capabilities 

through after action reports and 

improvement plans (AAR/IPs) 

• Re-evaluation of response capabilities 

following the approval and completion of 

corrective actions identified in a AAR/IPs

Additional performance measures are 

currently being implemented as well as 

pilot tested. Performance measures being 

implemented address the capabilities of 

crisis and emergency risk communication 

with the public, incident management, and 

laboratory services. Performance measures for 

epidemiological investigation, environmental 

exposure investigations, surveillance, and 

additional laboratory services are currently 

being pilot tested and will be implemented in 

the near future. 

About This Report 

This report presents a snapshot of public 

health preparedness based on available 

information on state, locality, and U.S. 

insular area activities receiving Terrorism 

Preparedness and Emergency Response 

funding. Data included in the fact sheet section 

of the report are from CDC (i.e., data related 

to the PHEP cooperative agreement and data 

from other CDC programs) as well as from the 

Association of Public Health Laboratories and 

the National Association of County and City 

Health Officials. CDC data were confirmed 

by both CDC subject matter experts and the 

PHEP-funded states and localities.

While these data do not represent all 

preparedness activities occurring in states, 

The 2008-2009 

economic crisis 

had a negative 

impact on state 

investments in 

public health 

programs.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 13 Background

localities, and U.S. insular areas, they 

significantly expand on the information 

provided in CDC’s first state preparedness 

report

31 Both reports provide the most 

comprehensive picture available on the 

breadth of state public health preparedness 

and response efforts. Fact sheets in this report 

cover activities occurring primarily from 

October 1, 2007 to September 30, 2008 (FY 

2008). In addition, some data from 2009 are 

included in this report. All data sources and 

timeframes are described in appendix 7. 

CDC has now released three preparedness 

reports; this is CDC’s second report featuring 

state-by-state data. It includes updates (when 

available) to data presented in CDC’s first state 

report, Public Health Preparedness: Mobilizing 

State by State (2008)32 as well as new data on 

state and local preparedness activities. CDC’s 

2009 report, Public Health Preparedness: 

Strengthening CDC’s Emergency Response33

broadly described CDC activities supported 

by Terrorism Preparedness and Emergency 

Response funding. CDC, ASPR, and public 

health partners continue to work together 

to better define and measure national public 

health preparedness to ensure that federal 

funds are invested wisely in ensuring our 

national readiness to prevent, mitigate, and 

respond to all types of public health emergencies. 

This report is organized into two main sections 

and seven appendices:

Section 1 begins with a description of 

surveillance and epidemiology activities and 

their importance to emergency preparedness. 

Following that are descriptions and national-level 

data on laboratories and response readiness 

activities critical to preparedness in states and 

localities. Section 1 concludes with information 

on additional preparedness activities funded by 

CDC that enhance preparedness at state and local 

levels. 

Section 2 presents fact sheets with information 

on a broad range of preparedness activities in 

the 50 PHEP-funded states and the 4 localities 

of Chicago, the District of Columbia, Los Angeles 

County, and New York City. The fact sheets 

also include data on the prevalence of several 

chronic conditions in the state or locality, which 

should be considered when developing effective 

response plans, and information on additional 

CDC-funded projects and activities located in 

those areas.

Section 2 concludes with a discussion of 

preparedness activities and challenges in the 

eight PHEP-funded U.S. insular areas. These areas 

include the three territories of American Samoa, 

Guam, and the U.S. Virgin Islands; the two 

commonwealths of the Northern Mariana Islands 

and Puerto Rico; and three freely associated 

states of the Federated States of Micronesia, the 

Republic of the Marshall Islands, and the Republic 

of Palau. 

Appendices 1-7 provide explanations of the 

fact sheet data points in the report and their 

significance, an overview of CDC organizations 

involved in preparedness activities, funding 

tables, technical assistance review scores for 

the Cities Readiness Initiative of CDC’s Strategic 

National Stockpile, and data sources. 

Public Health Preparedness:

A CDC Report on the

 Public Health Emergency Preparedness

Cooperative Agreement

February 2008

Mobilizing State by State

A CDC Report on Terrorism Preparedness and 

Emergency Response (TPER) – Funded Activities

January 2009

Public Health Preparedness:

CS120712

Report available at

www.emergency.cdc.gov/publications/jan09phprep

This report was developed by the Coordinating Office for Terrorism Preparedness and 

Emergency Response, Centers for Disease Control and Prevention. 

Richard E. Besser, MD

Director

Stephanie Zaza, MD, MPH

Acting Senior Advisor to the Director

Ann O’Connor, MPA

Enterprise Communication Officer and Associate Director for Policy

Authors

Stacey Brawner, Analyst

Denise Casey, Analyst

Diane Caves, Analyst

Laurie Schnepf, Analyst

Other Contributors

CDC Office of the Director 

Coordinating Center for Environmental Health and Injury Prevention

Coordinating Center for Health Information and Service

Coordinating Center for Health Promotion

Coordinating Center for Infectious Diseases

Coordinating Office for Global Health

National Institute for Occupational Safety and Health

Subject Matter Experts Across CDC

Strengthening CDC’s Emergency Response

2008

2009

CDC Preparedness Reports

CDC preparedness reports 

demonstrate results, drive 

program improvements, 

and increase accountability 

for federal investments.
Public Health in Action: 

Responding to Emergencies Across the Nation 

SALMONELLA December 2009, Multiple states – Salmonella

Typhimurium outbreak linked to frogs.

Public health officials investigated infections 

and determined source of outbreak.

December 2009, New Hampshire – Anthrax linked 

to animal hides. State health departments 

determined that a case of gastrointestinal anthrax 

was linked to hides used in drum making and a 

drumming circle.

 August 2009-Spring 2010,34 New Jersey and 

New York – Mumps outbreak. Investigations and 

testing led to identification of thousands of cases, 

most in religious communities.

June-July 2009, Multiple states – E.coli O157:H7

outbreaks linked to raw prepackaged cookie dough 

and to beef. Public health officials and federal agencies 

investigated outbreaks and identified associations with 

food sources. 

Spring 2009, Multiple states - 2009 H1N1 Influenza Pandemic. In April 2009, 

states began to implement their pandemic plans. Activities included disease 

monitoring, ongoing communication updates, appropriate use of mitigation 

measures, implementation of H1N1 vaccination campaigns, and the coordination 

of response efforts with partners.

February 2009, Nebraska – Salmonella Saintpaul 

outbreak linked to alfalfa sprouts. 235 persons 

from 14 states were infected; initial investigation by 

Nebraska health department led to investigations in 

13 additional states.

January 2009, Multiple states – Salmonella

Typhimurium outbreak linked to peanut butter.

Public health epidemiologists, sanitarians, and 

laboratorians led investigations for product recalls that 

stopped the spread of outbreaks.

Selected Biological Incidents

ANTHRAX

MUMPS

E. COLI

H1N1

SALMONELLA

SALMONELLA

14 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State
While state and local agencies devoted a significant amount of their time, energy, and resources to respond 

to the 2009 H1N1 influenza pandemic, many other events also required their attention and expertise. 

Support from CDC’s Public Health Emergency Preparedness cooperative agreement helped state and local public 

health departments build and strengthen their abilities to respond effectively. Below are examples of biological 

incidents and natural disasters – including H1N1 – to which state and local health departments responded. 

December 2009, Northeast U.S. – Severe Winter Weather. Public health 

officials issued guidance for staying safe and healthy during severe 

snow storms. Guidance included protection against hypothermia, 

carbon monoxide poisoning from indoor heaters, and preparations 

for extended periods of confinement. 

September 2009, American Samoa – Tsunami 

Response. A magnitude 8.0 earthquake 

generated three separate tsunami waves. Public 

health and partners worked together to ensure 

appropriate medical response.

September 2009, Multiple states – Southeast 

U.S. Floods. Public health officials provided 

guidance on sanitation, hygiene, and safety 

to protect against disease and injury to the 

thousands affected by floods. 

April-May 2009, Multiple states – Wildfires. Public health officials

issued guidance about air quality and care and services for 

evacuees, evacuation centers, at-risk populations, and responders. 

The health department also issued guidance that addressed 

exposures, clean up from fires, and subsequent response. 

February 2009, Kentucky – Ice Storm. Severe storm caused 36 deaths 

and left 770,000 residents without power. State health department 

secured equipment for shelters, provided prescription medications 

to individuals in shelters, and issued guidance on food safety and 

other public health issues related to power outages.

March 2009, Alaska – Volcano. Mt. Redoubt eruption 

cloud estimated at 50,000 feet. Public health 

officials monitored ash plume and issued air quality 

assessments, evacuation recommendations, and 

instructions for at-risk persons. 

March 2009, North Dakota – Floods. Public health 

officials coordinated evacuations, temporary 

housing, healthcare for acute injuries and other 

long-term health risks including hypothermia, 

bacteria, and mold.

Selected Natural Disasters

SEVERE 

WINTER 

WEATHER

TSUNAMI

FLOODS

WILDFIRES

ICE STORMS

VOLCANO

FLOODS

Note: Information on pages 14-15 is adapted from a fact sheet from the Association of State and Territorial Health Officials.35

Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 15
16 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot

1

Section 1: A National Snapshot of Public 

Health Preparedness Activities

• Surveillance and Epidemiology: Monitoring and Investigating 

Health Threats

• Laboratories: Identifying and Understanding Emerging Public 

Health Threats

• Response Readiness: Communicating, Planning, Exercising, 

and Evaluating

• Additional CDC Resources Supporting Preparedness in States 

and Localities 

• Moving Forward
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 17National Snapshot: Surveillance and Epidemiology

1

Surveillance and Epidemiology: 

Monitoring and Investigating 

Health Threats

Surveillance and epidemiology are core public health functions that detect 

community health threats, investigate their 

sources and patterns of distribution, and 

monitor their impacts. These data are used to 

help in making decisions on actions meant to 

control or prevent disease or injury. 

Surveillance: Data for Monitoring 

Health Threats

Public health surveillance is the ongoing, 

systematic collection, analysis, and 

interpretation of health data, and the 

dissemination of this information to those who 

need to know. Surveillance data may describe 

health problem trends, detect epidemics, 

provide details about disease patterns, 

monitor changes in disease agents like viruses 

(through working with laboratorians), help 

determine the most effective mitigation 

strategies, and evaluate the effects of control 

and prevention measures. 

Public health officials use different types 

of surveillance data as a basis for decision 

making to protect the public’s health. One of 

the first examples of a public health action 

stemming from the use of surveillance data 

likely occurred during the bubonic plague in 

the 14th century, when authorities boarded 

ships to prevent passengers with plague 

symptoms from coming ashore. Many early 

surveillance systems were based on identifying 

and reporting cases of disease.

In the United States, surveillance systems are 

a collaborative effort between CDC and its 

many partners in state, local and territorial 

health departments; public health and 

clinical laboratories; vital statistics offices; 

healthcare providers; clinics; and emergency 

departments. These surveillance systems 

resources helped support decision making by 

public health officials during the 2009 H1N1 

influenza pandemic response (see boxes below 

and on next page).

US VIRGIN ISLANDS PUERTO RICO

GUAM

DISTRICT OF COLUMBIA

No Report

No Activity

Sporadic

Local

Regional

Widespread

Surveillance resources 

such as FluView, CDC’s 

report on influenza 

disease activity, help 

support decision making 

by public health officials 

during outbreaks, 

including the 2009 H1N1 

influenza pandemic.

Source: CDC

FluView
18 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Surveillance and Epidemiology

1

Current surveillance systems at the local, 

state, national, and international levels need 

to improve to meet the nation’s growing 

challenge to manage and integrate data from 

a variety of different sources, ensure that 

decision makers have access to the data, and 

exchange data with other federal agencies 

and with public health partners. In 2007, 

Homeland Security Presidential Directive 21 

called for the development of a nationwide 

approach to enhance the United States’ 

ability to detect and respond to health-related 

threats. The National Biosurveillance Strategy 

for Human Health, an effort coordinated by 

CDC for the U.S. Department of Health and 

Human Services, provides a plan for building 

a nationwide, next-generation capability 

designed to generate timely, comprehensive, 

and accessible information for public health 

and clinical decision making.36 The Strategy 

established six priority areas: electronic health 

information exchange, electronic laboratory 

information exchange, unstructured data, 

integrated biosurveillance information, global 

disease detection and collaboration, and 

biosurveillance workforce. 

Supporting the 2009 H1N1 Influenza Pandemic Response

CDC supported numerous resources that were critical for responding rapidly to the 2009 

H1N1 influenza pandemic. Resources included support for domestic and global laboratory and 

surveillance systems; epidemiological and laboratory capacity and expertise; vaccine distribution 

and monitoring of the vaccination program; and communications, partnerships, and pandemic 

preparedness activities. These resources supported decisions at international, federal, state, and 

local levels aiming to slow the rapid spread of illness and limit morbidity and mortality. 

Surveillance data and epidemiological investigations from the 2009 H1N1 influenza pandemic 

revealed that certain health conditions increased the risk of being hospitalized from 2009 H1N1 

influenza. These conditions included lung diseases like asthma or chronic obstructive pulmonary 

disease, diabetes, heart disease, neurologic disease and pregnancy. Knowledge about these risks 

helped decision makers prioritize groups who would receive the first vaccines. The data also 

helped public health officials establish guidelines on antiviral treatment; how long people should 

stay home while ill; and the steps healthcare personnel, schools, businesses, community- and 

faith-based organizations, parents, and others needed to take to prevent infection. 

Epidemiology: Investigating 

Health Threats

Epidemiologists – known as “disease 

detectives” – work closely with laboratorians 

to identify health threats, determine their 

patterns in a community, and estimate their 

effects. They might identify contaminated 

food causing illness, assess the number 

and locations of people injured and types 

of injuries resulting from a disaster, or 

determine causes of a sudden onset of fever 

in a community. Epidemiologists also work to 

minimize the negative effects of community 

health threats.

Detection depends on accurate and complete 

surveillance data. Problems can arise if data 

are not available, especially for state and local 

health agencies. In particular, health problems 

may not be identified early and public health 

interventions (e.g., the provision of treatments 

or vaccines) may be delayed. 

Epidemiologists conduct targeted investigations and surveys that complement 

surveillance to validate and identify the causes 

and effects of a health event. Analyses of 

these data can produce criteria (e.g., specific 

symptoms) for determining whether a person 

should be counted as affected by the particular 

event, the characteristics of those affected 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 19National Snapshot: Surveillance and Epidemiology

1

H1N1

Enhancing Surveillance in Kansas to Assess Impact 

of the 2009 H1N1 Influenza Pandemic 

The Kansas Department of Health and Environment strengthened its surveillance 

capabilities to provide comprehensive state-level, regional, and local information 

on the impact of 2009 H1N1 influenza. Using resources from CDC’s Public Health 

Emergency Response funding, Kansas increased the number of sites in the 

Influenza-like Illness Surveillance Network statewide from 22 to 73. This one-time 

funding also supported the development of a hospital-based reporting system 

assessing hospitalization rates, a school absenteeism surveillance system, and 

comprehensive weekly surveillance and epidemiology reports that updated 

responders on the ongoing situation. 

Source: Association of State and Territorial Health Officials (2010)

(e.g., age, medication use, socioeconomic 

status), and the geographic extent of 

the event. Further studies help identify 

populations at increased risk for the disease or 

other health event. 

CDC epidemiological support to states and 

localities for FY 2008 included 26 Career 

Epidemiology Field Officers (CEFOs) located 

in states and localities supported through 

state Public Health Emergency Preparedness 

(PHEP) funding. CDC also deployed 71 field 

officers from its Epidemic Intelligence Service 

(EIS) to conduct 319 investigations in the 

same year. EIS is a two-year epidemiology 

training program modeled on a traditional 

medical fellowship. Officers in this program 

support states during responses to routine 

public health incidents and large-scale national 

emergencies. CEFOs are experienced, fulltime epidemiologists located in state and local 

public health departments to enhance and 

build epidemiologic capacity for public health 

preparedness and response. 

State epidemiological capacity continues to 

decline. A 2009 assessment37 by the Council 

of State and Territorial Epidemiologists 

reports that national epidemiological capacity 

has been eroding since 2004 (see Table 1). 

This trend contrasts with the significant 

increase in the number of epidemiologists 

that took place during 2001–2004, when 

emergency response and preparedness 

funds fueled rapid growth in the number of 

new and replacement epidemiologists in the 

public health workforce. The 2009 assessment 

also suggests that nearly 20% of current public 

health epidemiologists anticipate retiring 

or changing careers in the next 5 years and 

recommends that federal, state, and local 

agencies develop a strategy to address these 

projected downward trends and major gaps. 

Table 1: Epidemiological Capacity in the 50 States and the District of Columbia Health 

Departments; 2004-2009

2004 2009 Percent

Decrease

Number of epidemiologists working in state health departments 2,498 2,193 12%

Number of state health departments reporting substantial-to-full 

capacity in bioterrorism/emergency response 41 37 10%

Source: Council of State and Territorial Epidemiologists

H1N1
20 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Surveillance and Epidemiology

1

Tracking the Impact of Hazardous 

Substance Incidents

The Hazardous Substances Emergency 

Event Surveillance system* works to reduce 

injury and death among first responders, 

employees, and the general public 

that result from releases of hazardous 

substances. By collecting data on hazardous 

substance releases and tracking subsequent 

health effects, it allows state public health 

officials to assess vulnerabilities and 

proactively plan for prevention and timely 

response. In FY 2008, this program tracked 

8,150 hazardous substance incidents, 

2,290 injuries, and 67 fatalities sustained 

in hazardous substance incidents, and 606 

incidents that led to ordered evacuations of 

48,464 people in 14 states.**

 * As of September 30, 2009, the name of this program changed 

to the National Toxic Substance Incident Program. Seven states 

will be funded under the FY 2010 program announcement. 

** The number of people evacuated does not include 

evacuees in incidents where a precise number is 

unavailable.

Source: CDC, Office for State, Tribal, Local and Territorial 

Support (2008) 

Assessing Capabilities for 

Surveillance and Epidemiology

CDC is developing performance measures 

related to surveillance and epidemiological 

capabilities. PHEP-funded states, localities, 

and U.S. insular areas will be required 

to report on measures that address the 

following:

• Timely recognition of a potential health 

emergency through disease reports 

submitted to public health agencies

• Ability to investigate an outbreak or 

exposure, summarize findings, and make 

improvements to the investigative process

• Timeliness of initiating interventions to 

limit the spread of disease

The intent of these new measures is to 

demonstrate an ability to turn data into 

actionable information that supports 

decision making in a public health 

emergency. For more information on new 

performance measures, see the Moving 

Forward section on page 38.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 21National Snapshot: Laboratories

1

Laboratories: Identifying and 

Understanding Emerging Public 

Health Threats

L

aboratories identify disease agents, toxins, 

and other health threats found in tissue, 

food, or other substances. Rapid detection 

and characterization of health threats is 

essential for implementing appropriate control 

measures. Identification of the bacterium 

Salmonella Typhimurium in some peanut 

butter products in 2008-2009, for example, led 

to product recalls that stopped the spread of 

illness due to this bacterium.38 The ability to 

detect and characterize health threats relies 

on the availability of laboratory resources 

(including personnel), accurate and consistent 

methods, and quick data exchange systems.

CDC manages the Laboratory Response 

Network (LRN), a group of local, state, 

federal, and international laboratories with 

unique testing capabilities for confirming 

high priority biological and chemical agents. 

Located strategically across the United 

States and abroad, LRN member laboratories 

play a critical role in their state or locality’s 

overall emergency response plan to detect, 

characterize, and communicate about 

confirmed threat agents. Members perform 

standardized tests yielding reliable results 

within hours. Approximately 90% of the U.S. 

population lives within 100 miles of an LRN 

laboratory, decreasing the time needed to 

begin the response to a terrorist attack or 

naturally occurring outbreak. 

Highlights of state and locality laboratory 

activities related to preparedness appear on 

the following pages. See the summary table on 

page 26 for national-level data on laboratory 

activities (Table 3). 

The Laboratory Response 

Network is a group of 

local, state, federal, and 

international laboratories 

with unique testing 

capabilities for confirming 

high priority biological 

and chemical agents. 

Approximately 90% 

of the U.S. population 

lives within 100 miles 

of a laboratory in the 

Laboratory Response 

Network. 

Source: CDC
22 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Laboratories

1

Nationwide Testing for Responding 

to Biological Threats

The LRN was established in 1999 to create 

national laboratory capacity for testing 

biological threat agents and dangerous toxins.

Specific examples of biological threats include 

anthrax, smallpox, plagues, and botulism.39

LRN biological laboratories are designated as 

national, reference, or sentinel laboratories. 

• National laboratories, including those at 

CDC, have the most advanced capabilities. 

These laboratories are responsible for 

specialized strain characterizations, 

bioforensics, select agent activity, and 

handling highly infectious agents. 

• Reference laboratories perform tests to 

detect and confirm the presence of a 

threat agent. 

• Sentinel laboratories are primarily hospitalbased and can test samples to determine 

whether they should be shipped to other 

laboratories for further testing. 

In FY 2008, a total of 151 LRN laboratories 

in the United States could test for biological 

agents; 148 of these were reference 

laboratories and 3 were national laboratories. 

These laboratories maintain relationships 

with numerous sentinel laboratories in their 

jurisdictions that refer suspicious specimens to 

them for more advanced testing. 

CDC funded 54 LRN public health laboratories 

in FY 2008, one in every state and one in the 

District of Columbia (with the exception of 

California, Illinois, and New York, which have 

two laboratories) as part of the Public Health 

Emergency Preparedness (PHEP) cooperative 

agreement. Additional laboratories that 

participate in the LRN include state and 

locally funded public health laboratories 

as well as federal, military, international, 

university, agricultural, veterinary, food, and 

environmental testing laboratories. 

LRN laboratories could be reached 24/7. 

Because emergencies can happen day or 

night, emergency contacts for LRN member 

laboratories must be accessible 24 hours a day. 

In FY 2008, CDC successfully contacted 135 

out of 151 LRN biological laboratories during a 

non-business hours telephone drill.

Laboratories improved their abilities to 

rapidly identify disease-causing bacteria.

States must be able to detect and determine 

the extent and scope of potential outbreaks 

and minimize their impacts. PHEP-funded 

states must report on their ability to test 

for two bacteria and report results within 

a target timeframe of 4 working days (a 

CDC performance measure; see page 12). 

Laboratories in the PulseNet network40

(coordinated by CDC and consisting of 

public health and food regulatory agency 

laboratories) use CDC’s pulsed-field gel 

electrophoresis (PFGE) protocols to rapidly 

identify specific strains of Escherichia coli 

O157:H7 and Listeria monocytogenes

States are improving their abilities to rapidly 

identify these bacteria. The number of states 

that submitted at least 90% of Escherichia coli

and Listeria monocytogenes test results to CDC 

within 4 working days increased from 2007 to 

2008 (Table 2).

A scientist at 

a state public 

health laboratory 

tests a tomato 

sample during 

an investigation 

into a multistate 

Salmonella

outbreak. 

Photo source: New 

Mexico Department 

of Health
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 23National Snapshot: Laboratories

1

Table 2: Rapid Identification of Disease-Causing Bacteria by PulseNet Laboratories; 2007-2008

Disease-Causing Bacteria

Number of states submitting at least 90% of test 

results to CDC’s PulseNet database within 4 working days

 2007* 2008** Percent Increase

Escherichia coli O157:H7 22 out of 48

(46%)

29 out of 50

(58%) 26%

Listeria monocytogenes

10 out of 30

(33%)

18 out of 32

(56%) 70% 

 *Data for the 50 states from the PHEP cooperative agreement Budget Period 7 (August 31, 2006 to August 30, 2007) 

**Data for the 50 states from the PHEP cooperative agreement Budget Period 8 (August 31, 2007 to August 9, 2008)

 Source: CDC, OPHPR (DSLR)

Most laboratories passed proficiency tests 

for detecting biological agents. CDC conducts 

proficiency testing to evaluate LRN reference 

and national biological laboratories’ abilities to 

receive, test, and report one or more suspected 

biological agents. If a laboratory is unable to 

successfully test for an agent within a specified 

period of time and report results, it will not 

pass the proficiency test. In FY 2008, LRN 

biological reference and national laboratories 

passed 261 out of 277 tests (94%) to identify 

biological agents in unknown samples. 

Nationwide Testing for Responding 

to Chemical Threats

In 2003, the LRN started testing clinical 

specimens to measure human exposure to 

toxic chemicals. LRN laboratories that can test 

for chemical agents are designated as Level 1, 

2, or 3. 

• Level 1 laboratories have the most 

advanced capabilities. These are surgecapacity laboratories that can test for an 

expanded number of agents, including 

nerve agents, mustard agents, and toxic 

industrial chemicals. They also maintain the 

capabilities of Level 2 laboratories.

• Level 2 laboratories test for a limited panel 

of toxic chemical agents. They also maintain 

the capabilities of Level 3 laboratories.

• Level 3 laboratories work with hospitals 

and other first responders to maintain 

competency in clinical specimen collection, 

storage, and shipment.

In 2009, a total of 56 LRN laboratories in the 

United States could handle and/or test for 

chemical agents; 10 of these were Level 1 

laboratories, 37 were Level 2 laboratories, and 

9 were Level 3 laboratories. 

A majority of LRN chemical laboratories 

demonstrated proficiency in core methods to 

rapidly detect and measure chemical agents. 

Level 1 and Level 2 chemical laboratories 

undergo proficiency testing to determine if 

they can use six core methods to rapidly detect 

and measure chemical agents that can cause 

severe health effects. These methods can help 

determine the scope of an incident, identify 

those requiring long-term treatment, assist 

with non-emergency medical guidance, and 

help law enforcement officials determine the 

origin of the agent. Laboratories are tested 

annually to evaluate ongoing proficiency in the 

six methods. 

In 2009, 34 out of 47 Level 1 and/or Level 

2 LRN chemical laboratories were able 

to demonstrate proficiency in all six core 

methods (an additional seven laboratories 

demonstrated capabilities in four or five core 

methods). It should be noted that the states 

and localities with Level 1 and/or Level 2 

laboratories that are not proficient in all six 

core methods may have completed extensive 

work in the two steps that precede proficiency 

testing: training and validation in the core 

methods. 
24 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Laboratories

1

H1N1

Some LRN laboratories also demonstrated 

proficiency in additional methods. Proficiency 

in additional methods – required for Level 

1 laboratories and optional for Level 2 

laboratories – demonstrates a more advanced 

level of preparedness capability. CDC’s LRN 

program for assessing proficiency in detecting 

and measuring chemical agents continues 

to evolve through the ongoing incorporation 

of additional methods. Because the list of 

additional methods continues to increase, 

state and local laboratories are not expected 

to be proficient in all additional methods. (As 

of September 2009, there were six additional 

methods.) 

In 2009, 26 out of 47 Level 1 and/or Level 

2 LRN chemical laboratories demonstrated 

proficiency in at least one additional 

method to rapidly detect chemical agents. 

CDC continues to work with public health 

laboratories to assist them in expanding their 

chemical laboratory capacity to prepare for 

and respond to chemical terrorism incidents 

or other emergencies involving chemicals. 

CDC also partners with the Association of 

Public Health Laboratories to ensure support 

for public health laboratories involved in 

responding to chemical-exposure events 

from all sources, including those related to 

terrorism.

Maintaining Core Laboratory 

Functions During An Emergency

Improvements are needed in continuity of 

operations plans, which ensure that core 

functions of state public health laboratories 

are not disrupted during emergencies. In 

FY 2008, 23 of the 51 state public health 

laboratories and the District of Columbia had 

Budget and Workforce Cuts, Virus Uncertainties Strain 

State Response to 2009 H1N1 Influenza Pandemic

Health officials anticipated and prepared for an influenza pandemic. The 

identification of a novel H1N1 influenza virus in April 2009, however, still stressed 

the response capabilities of the public health system. Although every state had 

laboratories with pandemic response plans in place, many were operating with a 

reduced workforce. Additional challenges to a rapid response included obtaining 

approved testing equipment and supplies, and training staff on the new testing 

protocols. Despite these difficulties, every state and the District of Columbia had at 

least one public health laboratory that could test for the 2009 H1N1 influenza virus 

by early June. 

While public health staff across the nation met these challenges by working long 

hours for several months, the response placed increased and unsustainable strain 

on a system already weakened by workforce shortages. Preparing adequately 

for future public health responses requires predictable and adequate longterm funding to improve infrastructure, staffing, and training in public health 

laboratories. In his May 2009 testimony to Congress, Daniel Sosin, MD, MPH, Acting 

Director of CDC’s Office of Public Health Preparedness and Response, noted that 

“with stronger laboratory capacity in states, we could accelerate the detection and 

study of new viruses such as the 2009 H1N1 virus, helping us to better understand 

and respond to emerging health threats.” 

Source: Association of Public Health Laboratories, On the Brink: H1N1 Drains Labs Hit by Cuts (2009)

H1N1
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 25National Snapshot: Laboratories

1

continuity of operations plans, 15 had state 

plans that included laboratory operations, 

and 13 were developing plans. More work 

is needed to ensure that laboratories can 

withstand emergencies.

National Snapshot of Laboratory 

Activities

A summary table of national-level data 

on laboratory activities in 2008 and 2009 

appears on the following page (Table 3). Note 

that these items represent available data 

for preparedness activities and do not fully 

represent all state and locality laboratory 

efforts. For individual state and locality 

information in the area of laboratory activities, 

see Section 2 starting on page 42. See 

appendix 1 for an explanation of data points.

States Facing Challenges in 

Maintaining Laboratorian Workforce

Laboratorians provide critical expertise to 

effectively identify and respond to public 

health emergencies. Their responsibilities 

during a public health event include testing 

to identify known agents and providing 

timely laboratory information to response 

agencies. 

According to a 2008 national survey, public 

health laboratories across the country 

are experiencing significant difficulties 

maintaining the highly skilled workforce 

of laboratorians necessary to ensure an 

effective response. State public health 

laboratory directors reported that the 

factors most severely impacting their 

workforce were hiring (41%) and retention 

(28%). For those reporting hiring as a 

primary concern, 36% identified lack of 

funding and 31% cited hiring freezes as 

impacting their ability to hire staff. 

Sources: Association of Public Health Laboratories (APHL), Summary on Standards Needed for Preparedness Education for Epidemiologists, Public Health Laboratorians, Public Health Nurses, 

and Environmental Health Specialists/Sanitarians (2007). APHL, 

State Public Health Laboratories: Sustaining Preparedness in an 

Unstable Environment (2008). 
26 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Laboratories

1

 Table 3: National Snapshot of Laboratory Activities

Laboratories: General

Maintaining core laboratory 

functions during an emergency

Status of laboratory continuity of operations plan (COOP) for 50 states and DC:

•	 23 out of 51 had a state public health laboratory COOP 

•	 15 out of 51 had a state COOP that included laboratory operations

•	 13 out of 51 had a COOP that was under development

 APHL; 8/31/2007-8/30/2008

Ensuring availability of 

Laboratory Response Network 

(LRN) laboratory results for 

decision making

53 out of 54 states and localities had a standardized electronic data system capable of 

messaging laboratory results between LRN laboratories and also to CDC 

 CDC, OSELS; as of 9/30/2008

Laboratories: Biological Capabilities

Participation in LRN for 

biological agents

148 out of 151 LRN laboratories were reference laboratories that could test for biological agents

The remaining 3 LRN laboratories were national laboratories that could test for 

biological agents

 CDC, OID (NCEZID); as of 9/30/2008

Assessing if laboratory 

emergency contacts could be 

reached 24/7

135 out of 151 LRN laboratories were successfully contacted during a non-business hours 

telephone drill

 CDC, OID (NCEZID); 8/2008

Evaluating LRN laboratory 

capabilities 

261 out of 277 proficiency tests were passed by LRN reference and/or national laboratories CDC, OID (NCEZID); 1/2008-9/2008

Rapid identification of diseasecausing bacteria by PulseNet 

laboratories

Rapidly identified E. coli O157:H7 using advanced DNA tests (PFGE): 

•	 50 out of 50 states performed tests on E.coli 0157:H7 samples

•	 29 out of 50 of the states that performed tests submitted at least 90% of test 

results to the PulseNet database within 4 working days

 CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

Rapidly identified L. monocytogenes using advanced DNA tests (PFGE): 

•	 32 out of 50 states performed tests on L.monocytogenes samples

•	 18 out of 32 of the states that performed tests submitted at least 90% of test 

results to the PulseNet database within 4 working days 

 CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

Assessing laboratory 

competency and reporting 

through exercises

49 out of 51 public health laboratories in 50 states and DC conducted exercises to assess the 

competency of sentinel laboratories to rule out bioterrorism agents 

 APHL; 8/31/2007-8/30/2008

Ability of CDC-funded LRN laboratories* to contact the CDC Emergency Operations Center 

within 2 hours during LRN notification drill: 

•	 35 out of 54 laboratories passed

•	 15 out of 54 laboratories did not participate

•	 4 out of 54 laboratories did not pass

*There is one CDC-funded LRN laboratory in DC and in each state, with the exception of CA, IL and NY, which have two. 

 CDC, OID (NCEZID); 3/2008

Laboratories: Chemical Capabilities

Participation in LRN for 

chemical agents (LRN-C) 

56 LRN-C laboratories in states and localities could respond if the public was exposed to 

chemical agents: 

•	 10 out of 56 are Level 1 laboratories (most advanced testing capabilities) 

•	 37 out of 56 are Level 2 laboratories (testing capabilities for limited panel of agents)

•	 9 out of 56 are Level 3 laboratories (specimen collection, storage, and shipment)

CDC, ONDIEH (NCEH); as of 9/14/2009

Evaluating LRN-C laboratory 

capabilities through proficiency 

testing

34 out of 47 Level 1 and/or Level 2 LRN-C laboratories successfully demonstrated all six core 

methods to rapidly detect chemical agents 

26 out of 47 Level 1 and/or Level 2 LRN-C laboratories successfully demonstrated at least one 

additional method to rapidly detect chemical agents 

 CDC, ONDIEH (NCEH); as of 9/14/2009

Assessing LRN-C laboratory 

capabilities through exercises

LRN-C laboratories ability to collect, package, and ship samples properly during LRN exercise: 

•	 49 out of 56 laboratories passed

•	 3 out of 56 laboratories did not participate

•	 4 out of 56 laboratories did not pass

 CDC, ONDIEH (NCEH); as of 11/9/09

25 out of 31 Level 1 and/or Level 2 LRN-C laboratories successfully demonstrated the ability 

to detect 2 chemical agents in unknown samples during the LRN Emergency Response Pop 

Proficiency Test (PopPT) Exercise*

*Not all Level 1 and Level 2 laboratories are eligible to participate in this exercise. 

 CDC, ONDIEH (NCEH); as of 8/31/2008

Level 1 LRN-C laboratories took an average of 98.3 hours to process and report on 500 

samples during the LRN Surge Capacity Exercise (range was 71 to 126 hours) 

 CDC, ONDIEH (NCEH); 1/9/2009
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 27National Snapshot: Response Readiness

1

Response Readiness: 

Communicating, Planning, 

Exercising, and Evaluating

While all response to public health emergencies begins at the local level, 

preparing for a response requires coordination 

among all levels of government as well as a 

clear understanding of expected roles and 

responsibilities. State and local public health 

departments continue to improve their 

response to threats by developing, exercising, 

and improving emergency response plans and 

responding to real incidents. Strengthening 

response capabilities and capacities also 

entails improving situational awareness 

through monitoring and communicating 

emerging health information. 

Highlights of state and locality activities to 

enhance response readiness follow. See the 

summary table on page 34 for national-level 

response readiness data (Table 8). 

Communicating Emerging 

Health Information

Rapid detection and communication of health 

threats allows public health officials to identify 

disease patterns and implement measures to 

lessen their spread and impact.

States and localities used rapid electronic 

methods to monitor and communicate 

emerging health information. All state and 

locality public health departments could 

receive urgent disease reports 24/7. In 

addition, state public health laboratories in 

47 states and the District of Columbia used 

rapid methods to communicate with sentinel 

laboratories and other partners for outbreaks, 

routine updates, and training events. 

Participation in testing helped ensure that 

states received electronic information rapidly. 

The ability of state and local public health staff 

to receive urgent emerging health information 

from CDC helps ensure that local problems are 

mitigated and national events are detected 

sooner. CDC conducts tests to identify and 

address problems in its Health Alert Network 

(HAN) and Epidemic Information Exchange 

(Epi-X) systems. These tests ensure that the 

systems will be fully operational during a real 

event. 

The HAN system, a component of CDC’s 

Public Health Information Network, transmits 

health alerts, advisories, and updates on 

urgent health events to more than one 

million recipients, including state and local 

public health practitioners, clinicians, and 

laboratories. The number of PHEP-funded 

areas responding to HAN test messages within 

30 minutes increased from 2007 to 2009 (see 

Table 4).

Epi-X, a secure, CDC web-based communication system, enables state and local health 

departments, poison control centers, and 

other public health professionals to access 

and share preliminary health surveillance 

information quickly. Epi-X scientific staff are 

available 24/7 to provide assistance in editing 

Table 4: Communicating Emerging Health Information; 2007-2009

2007* 2009** Percent

Increase

State Public Health Departments Responding to 

HAN Test Message within 30 Minutes

39 out of 50

(78%)

48 out of 50 

(96%) 23%

 *Data for the 50 states as of August 2007 (District of Columbia also participated and passed)

** Data for the 50 states as of July 2009

 Source: CDC, OPHPR (DEO)
28 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Response Readiness

1

H1N1

and posting reports on the secure website. 

Staff also notify users routinely (by email) or 

as incidents arise (by pager, telephone, and 

email) about acute health events. To protect 

the sensitive nature of this information, 

access is limited to designated officials 

engaged in identifying, investigating, and 

responding to health threats. In FY 2008, 48% 

of approximately 5,500 active Epi-X users in 

the 50 states and the District of Columbia 

responded to a system-wide notification test 

that entailed logging into the system and 

viewing a report within the 3-hour targeted 

time frame. 

Planning

Responding to a public health emergency 

often requires complex logistical planning 

for activities such as the distribution of 

medicines or other supplies to a community. 

Because these activities involve many different 

community agencies, everyone involved in 

emergency response must plan strategies and 

regularly exercise them together. All 62 states, 

localities, and U.S. insular areas funded by 

the Public Health Emergency Preparedness 

(PHEP) cooperative agreement have plans for 

receiving, distributing, and dispensing medical 

assets from CDC’s Strategic National Stockpile 

and other sources. Assets include antibiotics, 

chemical antidotes, antitoxins, life-supporting 

medications, and medical supplies.

States can request these assets when local 

supplies are depleted or commercially 

unavailable. These assets, in combination with 

federal, state, and local technical expertise to 

manage and distribute them efficiently, help 

ensure the availability of key medical supplies 

during emergencies.

Preparing for Rapid Response to 

Radiological Incidents

Many states are pre-positioning treatments 

for radiological exposures to reduce the 

estimated response time should an incident 

occur. Calcium and zinc DTPA (diethylene 

triamine pentaacetic acid) are agents to treat 

people with internal contamination from 

plutonium, curium, or americium exposure. 

As of March 2010, 89% of the 62 PHEPfunded state, locality, and U.S. insular area 

public health departments received 78,880 

doses of calcium and zinc DTPA from CDC’s 

Strategic National Stockpile.

Source: CDC, Office of Public Health Preparedness and Response, 

Division of Strategic National Stockpile (2010)

Planning and Training Critical to California’s Rapid 

Response to the H1N1 Influenza Pandemic

All states, localities, and insular areas receiving PHEP funding develop and exercise 

plans to receive, store, distribute, and dispense supplies from the Strategic National 

Stockpile in the event of a public health emergency. Comprehensive planning 

and extensive training and testing prepared the California Department of Public 

Health to respond rapidly to the 2009 H1N1influenza pandemic. The state health 

department established an emergency operations center and activated the state 

warehouse. Operating on a 24/7 schedule, the state warehouse deployed about 

two million courses of antiviral drugs to local health departments in the first 

month of the pandemic alone, with the majority of shipments received by local 

health departments within 24 hours of request. Like the state health department, 

California’s local health departments report that previous Stockpile planning made 

efficient receipt, distribution, and dispensing of antiviral drugs possible. 

Source: Association of State and Territorial Health Officials (2010) 

H1N1
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 29National Snapshot: Response Readiness

1

Ability of states to receive, distribute, and 

dispense medical assets improved. CDC 

conducts annual technical assistance reviews 

(TAR) to assess Stockpile plans and works 

closely with state and local agencies to identify 

and address gaps. Areas of assessment include 

the public health department’s coordination 

with traditional and nontraditional community 

partners; the state’s ability to receive, store, 

stage, distribute, and dispense medical 

assets; the state’s legal statutes that aid 

rapid dispensing of assets; and the type and 

frequency of trainings and exercises. 

The number of states performing within an 

acceptable range in their plans to receive, 

stage, distribute, and dispense medical assets 

received from the Stockpile or other sources 

increased from 37 to 50 between 2006 and 

2009 (Table 5). (On a scale of zero to 100, a 

score of 69 or higher indicates that a state 

performed within an acceptable range.41) See 

individual fact sheets in Section 2 for statespecific scores. 

Table 5: CDC Technical Assistance Review of State Strategic National Stockpile Plans; 2006-2009

2006-2007 2007-2008 2008-2009

Acceptable (score of 69 to 100) 37 out of 50

(74%)

46 out of 50 

(92%)

50 out of 50 

 (100%)

Unacceptable (score of 0 to 68) 13 out of 50

(26%)

4 out of 50

(8%)

 _

Source: CDC, OPHPR (DSNS)

Major metropolitan statistical area scores 

improved over time. The Cities Readiness 

Initiative (CRI) of CDC’s Strategic National 

Stockpile focuses on enhancing preparedness 

in the nation’s largest cities and metropolitan 

statistical areas (MSAs), where more than 50% 

of the U.S. population resides. Through CRI, 

state and large metropolitan public health 

departments have developed plans to respond 

to a large-scale bioterrorist event within 48 

hours. CRI has also enhanced communication 

and collaboration among state and local public 

health departments, resulting in optimal use of 

shared resources. 

The CRI project began in 2004 with 21 cities 

and expanded to a total of 72 MSAs, with at 

least one CRI MSA in every state. 

• 2004: CDC funded 21 cities (Cohort I) 

• 2005: CDC funded 15 additional MSAs 

(Cohort II), for a total of 36 MSAs 

• 2006: CDC funded an additional 36 MSAs 

(Cohort III), for a total of 72 MSAs

MSAs can consist of one or more jurisdictions 

(e.g., counties, cities, and municipalities) and 

can extend across state borders, resulting in 

the representation of several states within 

one MSA. Reviews are conducted annually in 

each local jurisdiction to ensure continued 

readiness. Scores (ranging from 0 to 100) for 

each planning jurisdiction are combined to 

compute an average score for the CRI MSA. 

A score of 69 or higher indicates that the CRI 

location performed in an acceptable range in 

its plan to receive, distribute, and dispense 

medical assets from the Stockpile or other 

sources. Average scores for each CRI cohort 

demonstrate that scores improve the longer 

MSAs are in the program. The average scores 

for each CRI cohort are presented in Table 

6. (See appendix 6 for individual jurisdiction 

scores.)
30 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Response Readiness

1

Table 6: CDC Technical Assistance Reviews of Strategic National Stockpile Plans for Cities Readiness 

Initiative Locations; 2008

Cohort I

(established in 2004)

Cohort II

(established in 2005)

Cohort III

(established in 2006)

Acceptable (score of 69 to 100) 18 out of 21 

(86%)

10 out of 15 

(67%)

17 out of 36 

(47%)

Unacceptable (score of 0 to 68) 3 out of 21 

(14%)

5 out of 15 

(33%)

17 out of 36 

(47%)

Did not report scores - - 2 out of 36 

(6%)

Source: CDC, OPHPR (DSNS)

New Mexico and Illinois Pre-position Drugs to Ensure Availability for the 

2009 H1N1 Influenza Pandemic 

Operation “Cache-Out” Exercise

With funding from the Cities Readiness 

Initiative, two local health departments in 

Utah collaborated with community partners to 

conduct exercises that tested the ability to use 

bank and credit union drive-through windows 

for dispensing antibiotic or antiviral drugs to 

the public during an emergency. 

These exercises required coordination by 

public health, the private 

sector, law enforcement, 

fire and emergency medical 

services, search and rescue, 

emergency management, 

and public information 

groups.

Exercises and Incidents

State emergency operations centers (EOCs) 

conduct exercises and drills to practice 

response to emergency incidents. These 

hands-on sessions educate responders about 

response plans and their roles during an 

incident and identify needed improvements. 

Exercises help organizations assess their 

capabilities objectively, so that strengths 

and areas for improvement are identified, 

corrected, and shared as appropriate before a 

real incident. Exercises also help build working 

relationships across disciplines that do not 

work together routinely.

During a real incident, the state EOC serves as 

a facility for carrying out response planning 

and management of emergency situations, 

including ensuring continuity of operations. 

The common functions of all EOCs are to 

collect, gather, and analyze data; make 

decisions that protect life and property; 

maintain continuity of the organization 

and disseminate decisions to all concerned 

agencies and individuals. 

One of the most critical components of an 

EOC is its staff. They must be properly trained 

and have the authority to carry out actions 

necessary to respond to an emerging disaster. 

All 50 states and 4 localities must comply 

with National Incident Management System 

requirements, which includes training for 

staff in their roles and responsibilities during 

Photo source: Utah Department 

of Health

Average scores for 

each CRI cohort 

demonstrate that 

scores improve 

the longer 

MSAs are in the 

program. 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 31National Snapshot: Response Readiness

1

H1N1

New Mexico and Illinois Ensure Availability of Drugs 

for the 2009 H1N1 Influenze Pandemic

To ensure that local providers could respond rapidly to the 2009 H1N1 influenza 

pandemic, the New Mexico Department of Health pre-positioned (placed ahead of 

need) antiviral drugs with 178 public and private organizations that agreed to receive, 

distribute, and dispense the drugs. These arrangements helped ensure that their 

population, especially high-risk groups, had quick access to the medications. The state 

provided assets to acute care hospitals, health centers and clinics, pharmacies, and the 

Indian Health Service. 

Illinois pre-positioned both antiviral drugs and personal protective equipment 

with local health departments and hospitals as it anticipated an increase in 2009 

H1N1 influenza during the holidays and winter. The state also developed a backup 

transportation plan that did not rely on state-owned trucks – often needed for plowing 

snow – to resupply and pre-position the medical countermeasures.

Source: CDC, Office of Public Health Preparedness and Response, Division of Strategic National Stockpile (2009)

an emergency as outlined by the Incident 

Command System (ICS). The ICS specifies that 

states and localities have a pre-identified list 

of personnel required to cover eight core ICS 

functional roles: Incident Commander, Public 

Information Officer, Safety Officer, Liaison 

Officer, Operations Section Chief, Planning 

Section Chief, Logistics Section Chief, and 

Finance/Administration Section Chief.

All of the functional areas may or may not be 

used based on incident needs. The widespread 

use of ICS by all levels of government – 

federal, state, local, and tribal – as well as 

by many nongovernmental organizations 

and the private sector, enables personnel to 

work together using common terminology, 

procedures, and organizational structures. 

CDC’s EOC supports state response by serving 

as the point of contact for state agencies 

reporting potential public health threats. This 

centralized facility organizes the agency’s 

scientific experts in one location during an 

emergency, allowing efficient information 

exchange and connection with local, state, 

federal, and international partners. For 

multistate or severe emergencies, CDC can 

provide additional public health resources 

and coordinate response efforts across 

multiple jurisdictions. To support state and 

local efforts during an emergency, CDC’s EOC 

also coordinates deployment of CDC staff and 

equipment. 

States and localities demonstrated abilities 

to ensure rapid response. To ensure timely 

and effective coordination within the public 

health agency and with key response partners 

in a complex incident, PHEP-funded states 

and localities must demonstrate the capability 

to rapidly notify staff to report for EOC duty. 

They must also track staff responses to this 

notification to ensure that each of the eight ICS 

functional roles can be filled. Rapid notification 

of staff depends, in part, on maintaining 

accurate contact information for pre-identified 

public health agency staff to fill each ICS 

functional role. 

H1N1
32 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Response Readiness

1

Activation of Emergency Plan Speeds New York 

Response to the 2009 H1N1 Influenza Pandemic 

When the 2009 H1N1 influenza pandemic struck in spring 2009, New York 

activated the state’s public health emergency preparedness response plan. This 

action focused attention on the imminent public health threat and streamlined 

processes expediting successive emergency responses. A number of measures 

were implemented that enabled state, city, and county health departments to keep 

close surveillance of emerging cases and to react quickly to reduce the transmission 

rates and impact of the disease. Measures included developing a testing protocol to 

ensure identification of severe illness; monitoring resources for the most efficient use 

of medicines, masks, and other supplies; and implementing rapid internet reporting 

of suspected illness to provide complete, real time understanding of the unfolding 

situation. The Department of Health also maintained ongoing communication with 

counties, hospitals, other health care providers, and schools across the state to assure 

the most up-to-date information was available.

Source: New York State Office of the Governor (2009) 

In 2008, 53 out of 54 states and localities 

conducted or responded to a minimum 

of two drills, exercises, or real incidents 

to demonstrate rapid notification of preidentified staff that the EOC was activated. 

States and localities activated public health 

EOCs. An activation is defined as rapidly 

staffing all eight core ICS functional roles42 in 

the public health EOC with one person per 

position. PHEP-funded states and localities 

activated and staffed EOCs and evaluated 

response performance through after action 

reports. 

The number of states and localities that 

activated their public health EOC at least

Table 7: Activation of State and Locality Emergency Operations Centers; 2007-2008

2007* 2008** Percent 

Increase

Public health EOC activated at least twice as part 

of a drill, exercise, or real incident 

46 out of 54 

(85%)

48 out of 54 

(89%) 5%

 *Data for the 50 states and 4 localities of Chicago, the District of Columbia, Los Angeles County, and New York City from the PHEP 

cooperative agreement Budget Period 7 (August 31, 2006 to August 30, 2007) 

**Data for the 50 states and 4 localities of Chicago, the District of Columbia, Los Angeles County, and New York City from the PHEP 

cooperative agreement Budget Period 8 (August 31, 2007 to August 9, 2008)

 Source: CDC, OPHPR (DSLR) 

twice as part of a drill, exercise, or real 

incident (a CDC performance measure – see 

page 12) increased from 2007 to 2008 (see 

Table 7). In addition, 47 out of 54 states and 

localities conducted at least one unannounced 

activation. 

In a related performance measure, in 52 out 

of 54 states and localities, pre-identified staff 

reported to the public health EOC within 

the target time of 2.5 hours at least once.43

Although not every incident requires full 

staffing of the ICS, this capability is critical 

to maintain in case of large-scale or complex 

incidents. 

H1N1
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 33National Snapshot: Response Readiness

1

Evaluating Response Capabilities

States and localities evaluate their actions 

during both exercises and real incidents, 

identify needed improvements, and prepare 

plans for making improvements by developing 

after action reports and improvement plans 

(AAR/IPs). AAR/IPs should include how 

response operations did and did not meet 

objectives, recommendations for correcting 

gaps or weaknesses, and a plan for improving 

response operations.

In 2008, 52 out of 54 states and localities 

developed AAR/IPs at least twice following 

an exercise or real incident. In addition, 51 

out of 54 states and localities re-evaluated 

response capabilities following the approval 

and completion of corrective actions identified 

in AAR/IPs. 

National Snapshot of Response 

Readiness Activities

A summary table of national-level data on 

response readiness activities in 2008 and 

2009 appears on the following page (Table 

8). Note that these items represent available 

data for preparedness activities and do not 

fully represent all state and locality response 

efforts. For individual state and locality 

information in the area of response readiness, 

see Section 2 starting on page 42. See 

appendix 1 for an explanation of data points.
34 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Response Readiness

1

Table 8: National Snapshot of Response Readiness Activities

Response Readiness: Communication

Communicating emerging 

health information

54 out of 54 state and locality public health departments had a 24/7 reporting capacity system 

that could receive urgent disease reports any time of the day 

 State and locality data; 10/1/2007- 9/30/2008

48 out of 50 states responded to Health Alert Network (HAN) test message within 30 minutes 

 CDC, OPHPR (DEO); 7/2009

47 out of 51 state public health laboratories and DC used HAN or other rapid method (blast 

email or fax) to communicate with sentinel laboratories and other partners for outbreaks, 

routine updates, training events, and other applications 

 APHL; 8/31/2007-8/30/2008

48% of approximately 5,500 Epidemic Information Exchange users in 50 states and DC 

responded to a system-wide notification test within 3 hours 

 CDC, OPHPR (DEO); 4/3/2008

Improving public health 

information exchange

53 out of 54 states and localities participated in a Public Health Information Network forum 

(community of practice) to leverage best practices for information exchange 

 CDC, OSTLTS; as of 9/30/2008

Response Readiness: Planning

Assessing plans to receive, 

distribute, and dispense 

medical assets from the 

Strategic National Stockpile 

and other sources

States with acceptable* CDC technical assistance review scores:

•	 50 out of 50 states for 2008-2009

•	 46 out of 50 states for 2007-2008 

*A score of 69 or higher (out of 100) indicates state performed in an acceptable range in its plan to receive, distribute, and 

dispense medical assets. See state fact sheets for individual scores. 

CDC, OPHPR (DSNS); 2007-2008 scores are associated with funding from the PHEP 

cooperative agreement Budget Period 8 (8/13/2007-8/9/2008); 2008-2009 scores 

are associated with funding from Budget Period 9 (8/10/2008-8/9/2009)

Cities Readiness Initiative (CRI) locations with acceptable* scores: 

•	 18 out of 21 locations in CRI Cohort I (MSAs that enrolled in 2004)

•	 10 out of 15 locations in CRI Cohort II (MSAs that enrolled in 2005)

•	 17 out of 36 locations in CRI Cohort III (MSAs that enrolled in 2006)

*A score of 69 or higher (out of 100) indicates CRI location performed in an acceptable range in its plan to receive, distribute, and 

dispense medical assets. See appendix 6 for individual scores.

CDC, OPHPR (DSNS); as of 7/30/2008

Enhancing response capability 

for chemical events

1,941 CHEMPACK nerve-agent antidote containers placed in the 50 states and 

4 localities 

CDC, OPHPR (DSNS); as of 7/30/2008

Meeting preparedness 

standards for local health 

departments

150 local health departments in 24 states met voluntary Project Public Health Ready 

preparedness standards 

 NACCHO; as of 9/30/2008 

Response Readiness: Exercises and Incidents

Notifying emergency 

operations center staff

53 out of 54 states and localities notified pre-identified staff to fill all eight Incident Command 

System core functional roles at least twice due to a drill, exercise, or real incident 

Note: States and localities must report 2 and could report up to 12 notifications. 

 CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

53 out of 54 states and localities had pre-identified staff acknowledge notification at least once 

within the target time of 60 minutes 

 CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

52 out of 54 states and localities conducted at least one unannounced notification outside of 

normal business hours 

 CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

Activating the emergency 

operations center (EOC)

48 out of 54 states and localities activated their public health emergency operations center 

(EOC) at least twice as part of a drill, exercise, or real incident 

Note: States and localities must report 2 and could report up to 12 activations. 

 CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

52 out of 54 states and localities had pre-identified staff report to the public health EOC at least 

once within the target time of 2.5 hours 

 CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

47 out of 54 states and localities conducted at least one unannounced activation 

 CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

Response Readiness: Evaluation

Assessing response capabilities 

through after action report/

improvement plans (AAR/IPs)

52 out of 54 states and localities developed AAR/IPs at least twice following an exercise or 

real incident

Note: States and localities must report 2 and could report up to 12 AAR/IPs.

CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

52 out of 54 states and localities developed at least one AAR/IPs within the target time of 

60 days

CDC, OPHPR (DSLR); 8/31/2007-8/9/2008

51 out of 54 states and localities re-evaluated response capabilities following approval and 

completion of corrective actions identified in AAR/IPs

CDC, OPHPR (DSLR); 8/31/2007-8/9/2008
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 35National Snapshot: Additional CDC Resources

1

H1N1

Additional CDC Resources 

Supporting Preparedness in 

States and Localities 

CDC supports a variety of other programs and resources in the states and localities 

to enhance preparedness. These activities are 

described below and summarized in Table 9. 

Research, Training, Education, and 

Promising Demonstration Projects

Centers for Public Health Preparedness 

(CPHP). The CPHP program strengthens 

preparedness by linking academic expertise 

to state and local health agency needs. This 

program is an important resource for the 

development, delivery, and evaluation of 

preparedness education. CPHPs collaborate 

with state and other health agencies to 

develop, deliver, and evaluate preparedness 

education based on community need. In 

FY 2008, 28 colleges and universities within 

the CPHP program provided preparedness 

education to public health workers, healthcare 

providers, and students.

Preparedness and Emergency Response 

Research Centers (PERRC). PERRCs conduct 

research to evaluate the structure, capabilities, 

and performance of preparedness and 

emergency response activities in federal, 

state, and local public health systems. PERRC 

scientists must connect with multiple partners 

within the public health infrastructure to 

incorporate diverse perspectives into their 

research. In FY 2008, CDC awarded funding to 

seven accredited schools of public health for 

establishing PERRCs.44

Advanced Practice Centers (APC). This 

network of local health departments develops 

resources and training that enhance the 

capabilities of all local health departments

Centers for Public Health Preparedness Respond

 to the 2009 H1N1 Influenza Pandemic 

Academic-based Centers for Public Health Preparedness (CPHPs) provide learning 

opportunities to the public health workforce to strengthen their capabilities for 

responding to a crisis. During the 2009 H1N1 influenza pandemic, CPHPs provided 

subject matter expertise as well as training and technical assistance, and even 

helped enhance the state and local workforce capacity. 

•	 Faculty from several CPHPs were called upon to advise college and university 

campuses on the 2009 H1N1 influenza response, provide counsel on risk 

communication efforts in disadvantaged populations, and conduct numerous 

interviews with television, radio, web-based, and print media. 

•	 CPHPs developed free 2009 H1N1 influenza trainings for the public health 

workforce, and advised state and local health departments on continuity of 

operations planning and point-of-distribution site operations for flu vaccines. 

•	 Graduate students across the country volunteered their services to staff 

information hotlines and help investigate possible cases.

Source: Association of Schools of Public Health, H1N1 Report: Centers for Public Health (2009)

H1N1
36 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Additional CDC Resources

1

and the public health system to prepare for, 

respond to, and recover from public health 

emergencies. In FY 2008, there were seven 

APCs nationwide.

Centers of Excellence in Public Health 

Informatics. These Centers contribute to the 

efforts of CDC’s Public Health Informatics 

program by advancing the ability of healthcare 

professionals to communicate health 

recommendations to consumers, and by 

making the use of electronic information 

systems easier. They seek to improve the 

public’s health through discovery, innovation, 

and research related to health information and 

information technology. In FY 2008, there were 

five Centers.

Pandemic Influenza Promising Practices 

Demonstration Projects. In FY 2008, selected 

state and local public health departments 

received Public Health Emergency Preparedness 

(PHEP) cooperative agreement pandemic 

influenza supplemental funding through a 

competitive process for 55 projects serving as 

innovative approaches for pandemic influenza 

preparedness. The goal was to develop 

promising practices or effective approaches that 

can be replicated nationally to improve national, 

regional, and local public health detection and 

response to an influenza pandemic. 

Other CDC Resources Available to 

States and Localities

Epidemic Intelligence Service (EIS) Field 

Officers. The EIS program expands the 

epidemiology workforce through a two-year 

epidemiology training program modeled on 

a traditional medical fellowship. EIS officers 

(epidemiologists) serve as a critical component 

to CDC’s support of states and localities during 

responses to routine public health incidents 

and large-scale national emergencies. In 

FY 2008, 71 officers were assigned to state and 

local public health departments, where they 

conducted 319 epidemiologic investigations 

(e.g., public health response, research, 

and surveillance system evaluations) and 

functioned as an integral part of the health 

department.

Deployments of CDC staff to states. CDC 

personnel are deployed routinely for 

emergency response operations and EPI-AID 

investigations. For EPI-AID investigations, CDC’s 

EIS officers, along with other CDC staff, provide 

technical support to state health agencies 

requesting assistance for epidemiologic field 

investigations of disease outbreaks or other 

health emergencies. In FY 2008, there were 

84 incidents with a total of 381 CDC staff 

deployed. 

CDC’s Public Health Advisors and Career Epidemiology Field Officers 

Facilitate Preparedness Activities at State and Local Levels

Since 2002, CDC has placed public health advisors (PHAs) and Career Epidemiology 

Field Officers (CEFOs) in state and local health departments. (States use PHEP funds 

to support CEFO positions.) PHAs serve as liaisons for CDC and provide on-site 

program technical assistance, guidance, and coordination. Examples of their activities 

include building epidemiologic capacity; building partnerships with other agencies 

and stakeholders; leading or participating in state and/or local emergency response 

exercises; supporting planning and response for preparedness activities, including 

pandemic influenza; and providing substantive and strategic program advice and 

assistance.

Source: CDC, Office of Public Health Preparedness and Response 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 37National Snapshot: Additional CDC Resources

1

Career Epidemiology Field Officers 

(CEFOs). CDC places experienced, full-time 

epidemiologists in state and local public 

health departments to enhance and build 

epidemiologic capacity for public health 

preparedness and response. (States use PHEP 

funds to support CEFO positions.) CEFOs also 

serve as liaisons and consultants between 

CDC and public health departments, and 

as mentors for state and local public health 

department staff and EIS officers assigned to 

state or local health departments. In FY 2008, 

Table 9: Additional CDC Projects and Activites Enhancing Preparedness in States and Localities; 2008 

Research, Training, Education, and Promising Demonstration Projects Number 

Centers for Public Health Preparedness CDC, OPHPR (OD); FY 2008 28

Preparedness and Emergency Response Research Centers CDC, OPHPR (OD); FY 2008 7

Advanced Practice Centers NACCHO; FY 2008 7

Centers of Excellence in Public Health Informatics CDC, OSELS; FY 2008 5

Pandemic Influenza Promising Practices Demonstration Projects CDC, OPHPR (DSLR); FY 2008 55

Additional CDC Resources Supporting Preparedness in States and Localities Number 

Epidemic Intelligence Service CDC, OSELS; FY 2008

•	 Epidemic Intelligence Service Field Officers 

•	 Investigations conducted by Epidemic Intelligence Service Field Officers 

71

319

Deployments CDC, OPHPR (DEO); FY 2008

•	 Total number of incidents with deployments 

•	 Total number of CDC staff deployed 

84

381 

Career Epidemiology Field Officers CDC, OPHPR (OD); as of 9/30/2008 26*

Quarantine Stations CDC, OID (NCEZID); FY 2008 19**

 *One additional CEFO is located in American Samoa

**One additional quarantine station is located in Puerto Rico

26 CEFOs were located in 21 states and one 

CEFO was located in American Samoa. 

Quarantine Stations. In FY 2008, CDC’s 19 

domestic quarantine stations (one additional 

quarantine station is located in Puerto Rico), 

strategically located at U.S. ports of entry 

where the majority of international travelers 

arrive in the United States, helped detect 

and respond to diseases of public health 

significance. 
38 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Moving Forward

1

Moving Forward 

• Most states and localities demonstrated 

the ability to activate and rapidly staff their 

emergency operations centers for drills, 

exercises, or real incidents, and developed 

after action reports/improvement plans 

following these activities. (See Table 8 on 

page 34.)

CDC has identified the areas listed below for 

improving state and local preparedness.

Maintain preparedness gains and resolve 

gaps. Important gains have been made since 

CDC’s 2008 preparedness report in the areas 

of laboratory and response readiness. Data 

presented in this report show improvement 

in rapid laboratory testing for biological 

agents; and readiness to receive, distribute, 

and dispense assets from CDC’s Strategic 

National Stockpile. CDC will continue to work 

with state and local health departments to 

maintain these improvements and to identify 

and resolve gaps in these and other core 

capabilities important for preparedness and 

response. Improvements are needed in 

continuity of operations plans for state public 

health laboratories. 

State and local health departments are first responders for public health emergencies 

and CDC remains committed to strengthening 

their preparedness. Since 1999, CDC’s Public 

Health Emergency Preparedness (PHEP) 

cooperative agreement has helped strengthen 

state and local public health functions that 

are critical for preventing, responding to, and 

recovering from health threats. 

Much progress has been made to build 

and strengthen national public health 

preparedness and response capabilities. 

Accomplishments highlighted in this report 

include the following:

• Biological laboratory capabilities and 

capacities in place were strong in most 

states and localities. Most laboratories in 

the Laboratory Response Network (LRN) 

could be reached 24/7, rapidly identified 

certain disease-causing bacteria and sent 

reports to CDC, and passed proficiency 

tests for detecting other biological agents. 

(See Table 3 on page 26.)

• A majority of LRN chemical laboratories 

demonstrated proficiency in core methods 

for detecting and measuring exposure 

to chemical agents, and some were 

proficient in one or more additional 

methods identified by CDC as important for 

responding to chemical emergencies. (See 

Table 3 on page 26.)

• All states and localities could receive urgent 

disease reports 24/7, and most states 

used rapid methods (blast email or fax) 

to communicate with other laboratories 

for outbreaks, routine updates, and other 

needs. (See Table 8 on page 34.)

• All states and localities received acceptable 

CDC review scores for their plans to receive, 

distribute, and dispense medical assets 

from CDC’s Strategic National Stockpile and 

other sources. (See Table 8 on page 34.)

Preparedness is a continuous cycle 

of planning, organizing, equipping, 

training, exercising, evaluating, and 

taking corrective action to ensure 

effective coordination during incident 

response. 

Image source: Federal Emergency Management Agency

EVALUATE/

IMPROVE PLAN

ORGANIZE/

EQUIP

TRAIN

EXERCISE PREPAREDNESS

CYCLE
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 39National Snapshot: Moving Forward

1

Build on the successes and lessons learned 

from the response to the 2009 H1N1 influenza 

pandemic. The first influenza pandemic in 40 

years provided a real world test of our response 

capabilities. CDC is working with all levels 

and sectors of the public health and medical 

communities toward systematically assessing 

this response, developing plans to address 

gaps and challenges, and incorporating needed 

changes. Assessments will include tools such as 

after action reports/improvement plans.

Ensure continuous funding to build and 

maintain a skilled state and local public health 

workforce. The surge in effort needed to 

respond to the 2009 H1N1 influenza pandemic 

placed an increased strain on a system already 

weakened by workforce shortages and budget 

shortfalls. The response revealed that the 

combination of the continued erosion of the 

general all hazards preparedness capacities, 

infrastructure, and staffing, along with fiscal 

issues facing state and local governments 

proved to be challenging for public health 

departments. Preparing adequately for 

future outbreaks – and other public health 

emergencies that are inevitable and may 

occur simultaneously – requires predictable 

and adequate long-term funding to improve 

infrastructure, staffing, and staff training 

in the areas of surveillance, epidemiology, 

laboratories, and response readiness.

Expand performance measurement to 

assess and monitor preparedness activities 

and to drive program improvement and 

accountability. CDC will continue to work 

with state and local partners to develop new 

performance measures that are indicators of 

preparedness and response capabilities and 

align with the objectives of the National Health 

Security Strategy45 as well as the Pandemic 

and All-Hazards Preparedness Act.46 The goal 

of these efforts is to implement measures that 

address short-term activities and outcomes 

that can impact core preparedness functions in 

the long term. 

Major gaps exist for measuring preparedness 

in the areas of surveillance and epidemiology. 

Draft performance measures in these areas, as 

well as in laboratory activities are being pilot 

tested and will be refined based on results 

obtained and input from partners. 

While this report relied on available 

performance measurement data, future 

reports will provide information on more 

robust data generated from planned 

improvements in the new five-year PHEP 

program announcement that will go into effect 

in August 2011. As part of the development 

and implementation of the new program 

announcement, CDC is developing a PHEP 

capabilities model to better define the 

strategic focus and priorities of the PHEP 

program and a related planning tool to be used 

by states, localities, and territories to inform 

their program planning and priority setting. 

The PHEP planning tool also will be used to 

monitor progress in achieving PHEP objectives 

and capabilities annually and progressively 

over the course of the five-year cooperative 

agreement, driving program improvement and 

accountability. 

Since 1999, CDC’s PHEP 

cooperative agreement 

has helped strengthen 

state and local public 

health functions that are 

critical for preventing, 

responding to, and 

recovering from health 

threats. 

NATIONAL HEALTH

SECURITY STRATEGY

OF

THE UNITED STATES OF AMERICA

CDC is working collaboratively to implement 

the National Health Security Strategy that was 

established to galvanize efforts to minimize the 

health consequences associated with significant 

health incidents. 
40 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State National Snapshot: Moving Forward

1

Promote health and prevent disease, injury, 

and disability in communities. Healthy 

populations are more resilient to new health 

threats. State and local health departments 

must continue to strengthen their 

collaboration with individuals, families, and 

communities as essential partners in building 

resilience to all types of public health hazards. 

Building healthier communities also helps 

provide greater protection to populations who 

are more vulnerable during emergencies and 

supports broader CDC health protection goals 

and national health reform efforts. 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 41 Activities in States, Localities, and U.S. Insular Areas

2

Section 2: Public Health Preparedness 

and Response Activities in States, 

Localities, and U.S. Insular Areas

• Fact Sheets for 50 States and the 4 Localities of Chicago, the 

District of Columbia, Los Angeles County, and New York City 

• Overview of Preparedness in the U.S. Insular Areas: Territories, 

Commonwealths, and Freely Associated States
42 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Alabama

adph.org/CEP

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People with 

chronic conditions may require additional care such as specialized medications, equipment, 

and other assistance. To develop an effective response plan, a state or locality must 

consider the unique needs of its own population. In Alabama, 7.8% of adults reported 

having asthma, 11.2% diabetes, 8.1% heart disease, and 4.3% had a stroke. In addition, 

25.1% reported a limiting disability and 67.9% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included laboratory 

operations and the COOP was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

58

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

25 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

61% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 43 Fact Sheets

2

Alabama

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of Alabama at Birmingham - South 

Central Center for Public Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

7 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

7 out of 7 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

8

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

8 out of 8 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

—

—

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

92

2008-09:

86

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Birmingham, AL: 32

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

32

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
44 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Alaska

hss.state.ak.us/prepared

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Alaska, 9.6% of adults 

reported having asthma, 6.7% diabetes, 4.3% heart disease, and 2.1% had a stroke. In 

addition, 21.9% reported a limiting disability and 65.5% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

2 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

2 out of 2 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

5 out of 5 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

9 

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

3 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Did not 

pass

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

12 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

44% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 45 Fact Sheets

2

Alaska

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

3 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

3 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

3 out of 3 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

5 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

8

Deployments

 Type of Incident (number of CDC staff)18 Post Op Infections (2)

Career Epidemiology Field Officers15 None

Quarantine Stations19 Ted Stevens Anchorage International Airport, Anchorage

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

No

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

80

2008-09:

70

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Anchorage, AK: 74

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

2

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
46 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Arizona

azdhs.gov/phs/edc/edrp

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Arizona, 9.8% of adults 

reported having asthma, 7.8% diabetes, 6.7% heart disease, and 2.5% had a stroke. In 

addition, 21.6% reported a limiting disability and 61.3% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

30

93%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

4

75%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

0 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

90 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

61% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 47 Fact Sheets

2

Arizona

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of Arizona - College of 

Public Health $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

6 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

6 out of 6 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

5 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

5 out of 5 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

4

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

3 out of 4 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

13

Deployments

 Type of Incident (number of CDC staff)18

Salmonella Saintpaul (1); STD Testing False Negatives (2); 

Measles Outbreak (5); Drug Resistant Bacteria (2); Legionnaire’s Disease (1); 

Salmonella Montenvideo (3); Hazardous Drinking Water (4)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

83

2008-09:

85

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Phoenix, AZ: 72

*Cohort II: No sites

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

37

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
48 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Arkansas

healthyarkansas.com

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Arkansas, 8.3% of 

adults reported having asthma, 9.5% diabetes, 8.2% heart disease, and 3.5% had a stroke. 

In addition, 25.0% reported a limiting disability and 65.7% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

2 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

2 out of 2 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

20 

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

1

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

10 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

49% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 49 Fact Sheets

2

Arkansas

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Addressing Vulnerabilities in Populations $220,000

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

7 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

6 out of 7 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

4 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

4 out of 4 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

3 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

—

—

Deployments

 Type of Incident (number of CDC staff)18 Hurricane Gustav (1); Creutzfeldt-Jakob Disease (2); Neurological Illness (2)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

93

2008-09:

97

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Little Rock, AR: 51; Memphis, TN: 72

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

17

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
50 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

California

BePreparedCalifornia.ca.gov/epo

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In California, 8.4% of 

adults reported having asthma, 8.5% diabetes, 4.9% heart disease, and 2.2% had a stroke. 

In addition, 18.8% reported a limiting disability and 61.4% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a 

COOP that included laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

22 

reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

17 out of 

22 labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

28 out of 

30 tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

180 

90%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

16

94%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

1 passed 

(LAC), 

1 did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

One 

Level 2 

lab (LAC)

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

Level 1 

lab:

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

Level 1 

lab:

4 out of 4 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Level 1 

lab:

passed

Level 2 

lab (LAC):

passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Level 1 

lab:

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

Level 1 

lab:

112 hours

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

0 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

52% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

Laboratory data includes Los Angeles County (LAC); 

see separate fact sheet for LAC-specific data.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 51 Fact Sheets

2

California

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. Also see separate fact sheet for Los Angeles County-specific data.

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of California at Berkeley;

Loma Linda University

$525,760

$525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 Santa Clara County Advanced Practice Center $250,000

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Electronic Laboratory Data Exchange $800,627

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

9 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

8 out of 9 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

10 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

10 out of 

10 times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

2

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

6

29

Deployments

 Type of Incident (number of CDC staff)18 Dermopathy (1); Post Operation Infections (2); Measles Outbreak (1)

Career Epidemiology Field Officers15 1

Quarantine Stations19 San Francisco International Airport; San Francisco; 

Rosecrans Street, San Diego.

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

100

2008-09:

100

Cities Readiness Initiative (CRI) Metropolitan 

Statistical Area (MSA) and 2007-08 TAR score11

*Cohort I: Los Angeles, CA: 82; San Diego, CA: 82; 

 San Francisco, CA: 74

*Cohort II: Riverside, CA: 73; Sacramento, CA: 60; 

 San Jose, CA: 77

*Cohort III: Fresno, CA: 22

See Scoring Note above. 

CRI MSAs can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the MSA 

was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

165

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

5

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

Laboratory data includes Los Angeles County (LAC); 

see separate fact sheet for LAC-specific data.
52 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Los Angeles County

labt.org

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In Los Angeles County, 7.8% of 

adults reported having asthma, 9.9% diabetes, 4.4% heart disease, and 1.5% had a stroke. 

In addition, 16.4% reported a limiting disability and 60.4% were overweight or obese.* 

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

No data collected

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

Locality had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts can be 

reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

—

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

—

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercise(s) to 

assess competency of sentinel 

laboratories to rule out 

bioterrorism agents1

—

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drills3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, NY, and IL, 

which have two.

Passed

Laboratories: Chemical Capabilities

Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

4 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

Locality public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

—

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

—

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

—

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7Locality data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

See separate fact sheet

for California state data.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 53 Fact Sheets

2

Los Angeles County

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. Also see separate fact sheet for California state data. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of California at Los Angeles - Center 

for Public Health and Disasters $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center 

staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: Locality must report 2 and 

could report up to 12 notifications.

10 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

10 out of 

10 times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: Locality must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: Locality must report 2 and 

could report up to 12 AAR/IPs.

9 

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

9 out of 9 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

5

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 Tom Bradley International Airport, Los Angeles

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12See California fact sheet for CDC TAR state score 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

Cities Readiness Initiative (CRI) jurisdiction 2007-

2008 technical assistance review (TAR) score11,12

Los Angeles County: 81

(part of Cohort 1, which was established in 2004)

Scoring Note: A score of 69 or higher indicates 

a CRI jurisdiction performed in an acceptable 

range in its plan to receive, distribute, and 

dispense medical assets. 

See appendix 6 for the average TAR score for the 

metropolitan statistical area of Los Angeles, CA, 

which has multiple contributing jurisdictions in 

addition to Los Angeles County.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

65

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

See separate fact sheet

for California state data.
54 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Colorado

cdphe.state.co.us/epr

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Colorado, 8.1% of 

adults reported having asthma, 6.0% diabetes, 4.0% heart disease, and 1.9% had a stroke. 

In addition, 19.0% reported a limiting disability and 55.3% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

9 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

8 out of 9 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 5 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

86

99%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

6

33%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

3 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

2 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

53% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 55 Fact Sheets

2

Colorado

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Addressing Vulnerability in Populations;

Countermeasure and State Immunization 

Information Systems Integration; 

Electronic Laboratory Data Exchange

$94,000

$352,693

$354,269

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 4 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

4 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

4 out of 4 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

3

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

3 out of 3 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

6

Deployments

 Type of Incident (number of CDC staff)18 Salmonella (3); Salmonella (5); Aspergillus Infections (3); Liver failure (4)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

94

2008-09:

96

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Denver, CO: 90

*Cohort II: No sites

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

27

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
56 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Connecticut

ct.gov/dph

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Connecticut, 8.8% of 

adults reported having asthma, 6.8% diabetes, 5.0% heart disease, and 2.1% had a stroke. 

In addition, 18.8% reported a limiting disability and 59.7% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

33 

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

15

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

44 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

58% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 57 Fact Sheets

2

Connecticut

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 Yale University - Center for Public 

Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Addressing Vulnerabilities in Populations $370,000

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 4 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

3 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

3 out of 3 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

12

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

12 out 

of 12 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

9

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

84

2008-09:

94

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Hartford, CT: 42; New Haven, CT: 70

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

25

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

19

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
58 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Delaware

dhss.delaware.gov/dhss/dph

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Delaware, 9.6% of 

adults reported having asthma, 8.3% diabetes, 6.8% heart disease, and 2.9% had a stroke. 

In addition, 20.3% reported a limiting disability and 63.8% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

7 

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

5 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

9 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

50% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 59 Fact Sheets

2

Delaware

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

1 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

1 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

3 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

—

—

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

96

2008-09:

98

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Philadelphia, PA: 75

*Cohort II: No sites

*Cohort III: Dover, DE: 97

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

6

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
60 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

District of Columbia

bioterrorism.doh.dc.gov/biot/site

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In the District of Columbia, 9.6% of 

adults reported having asthma, 8.0% diabetes, 3.8% heart disease, and 2.7% had a stroke. 

In addition, 17.4% reported a limiting disability and 55.1% were overweight or obese.* 

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

Locality had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

3 reference 

labs

Assessing if 

laboratory 

emergency 

contacts can be 

reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

2 out of 3 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

1 out of 1 

test

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

—

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

—

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

Locality public health 

laboratory conducted 

exercise(s) to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drills3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

0 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Did not 

participate

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

Locality public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

—

Locality public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

3 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

29%

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7Locality data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 61 Fact Sheets

2

District of Columbia

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness14 — N/A

Preparedness and Emergency Response Research Centers14 — N/A

Advanced Practice Centers15 — N/A

Centers of Excellence in Public Health Informatics16 — N/A

Pandemic Influenza Promising Practices Demonstration Projects13 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center 

staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident13 

Note: Locality must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes13

4 out of 4

 times

Conducted at least one 

unannounced notification outside 

of normal business hours13

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident13

Note: Locality must report 2 and 

could report up to 12 activations.

4 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours13

4 out of 4 

times

Conducted at least one 

unannounced activation13 No

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident13

Note: Locality must report 2 and 

could report up to 12 AAR/IPs.

3 

AAR/IPs

AAR/IPs developed within target 

time of 60 days13

3 out of 3 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs13

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers16

 Investigations conducted by Epidemic Intelligence 

Service Field Officers16

1

1

Deployments

 Type of Incident (number of CDC staff)17 Hurricane Gustav (2); HIV Investigation (3)

Career Epidemiology Field Officers14 —

Quarantine Stations18 Dulles International Airport, Washington, District of Columbia

13CDC, OPHPR (DSLR); 2008 14CDC, OPHPR (OD); 2008 15NACCHO; 2008 16CDC, OSELS; 2008 17CDC, OPHPR (DEO); 2008 18CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12NACCHO; 2008 13CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

Cities Readiness Initiative (CRI) jurisdiction 2007-

2008 technical assistance review (TAR) score11

District of Columbia: 94

(part of Cohort 1, which was established in 2004)

Scoring Note: A score of 69 or higher indicates 

a CRI jurisdiction performed in an acceptable 

range in its plan to receive, distribute, and 

dispense medical assets. 

See appendix 6 for the average TAR score for 

the metropolitan statistical area of the National 

Capitol Region, which has multiple contributing 

jurisdictions in addition to the District of 

Columbia.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

5

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards12

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
62 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Florida

doh.state.fl.us/demo/php

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Florida, 6.6% of adults 

reported having asthma, 9.5% diabetes, 7.9% heart disease, and 3.2% had a stroke. In 

addition, 19.2% reported a limiting disability and 60.2% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a 

COOP that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

5 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

4 out of 5 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

12 out of 

15 tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

19 

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

9

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

One

Level 3 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

Level 1 

lab:

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

Level 1 

lab: 

4 out of 4 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Level 1

 lab: 

passed

Level 3 

lab:

did not 

participate

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Level 1 

lab: 

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

Level 1 

lab:

123 hours

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

19 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

46% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 63 Fact Sheets

2

Florida

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of South Florida - Florida Center for 

Public Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Electronic Death Reporting; 

Electronic Laboratory Data Exchange

$562,828 

$729,970

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

12 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

12 out of 

12 times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

10 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

10 out of 

10 times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

5 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

16

Deployments

 Type of Incident (number of CDC staff)18 Hurricane Gustav (2)

Career Epidemiology Field Officers15 1

Quarantine Stations19 Miami International Airport, Miami

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

95

2008-09:

98

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Miami, FL: 87

*Cohort II: Orlando, FL: 81; Tampa, FL: 87

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

108

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

17

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
64 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Georgia

health.state.ga.us/programs/emerprep

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Georgia, 8.5% of adults 

reported having asthma, 9.9% diabetes, 6.0% heart disease, and 2.5% had a stroke. In 

addition, 18.5% reported a limiting disability and 64.7% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

5 reference 

labs, 

1 national 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

6 out of 6 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

49 

84%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

22

77%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

0 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

28 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

32% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 65 Fact Sheets

2

Georgia

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 Emory University - Emory Center for Public 

Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15

Emory University - Create and Maintain 

Sustainable Preparedness and 

Response Systems

$1,562,676

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Collaborative Planning for Delivery of 

Essential Healthcare Services $777,671

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

3 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

12

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

12 out of 

12 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

3

11

Deployments

 Type of Incident (number of CDC staff)18 Hurricane Gustav (15); Rabies (1); MRSA Control Measures (1)

Career Epidemiology Field Officers15 1

Quarantine Stations19 Hartsfield-Jackson Atlanta International Airport, Atlanta

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

73

2008-09:

90

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Atlanta, GA: 59

*Cohort II: No sites

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

58

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

14

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
66 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Hawaii

hawaii.gov/health/emergencyprep

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Hawaii, 9.6% of adults 

reported having asthma, 8.2% diabetes, 4.8% heart disease, and 2.6% had a stroke. In 

addition, 16.8% reported a limiting disability and 57.3% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

3 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

3 out of 3 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

2 out of 2 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

32

78%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

6

83%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

No

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

6 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

51% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 67 Fact Sheets

2

Hawaii

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts.

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Countermeasure and State Immunization 

Information Systems Integration;

Distribution and Dispensing of Antiviral 

Drugs to Self-isolated/quarantined Persons; 

Electronic Laboratory Data Exchange;

Public Engagement

$350,374

$136,255 

$718,000 

$178,112

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

1 time

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

1 out of 1 

time

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

5 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

4

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 2

Quarantine Stations19 Honolulu International Airport, Honolulu

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

74

2008-09:

84

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Honolulu, HI: 51

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

6

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
68 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Idaho

healthandwelfare.idaho.gov

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Idaho, 8.9% of adults 

reported having asthma, 7.0% diabetes, 5.7% heart disease, and 2.3% had a stroke. In 

addition, 22.6% reported a limiting disability and 62.2% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

31 

68%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

7 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

59% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 69 Fact Sheets

2

Idaho

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

10 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

10 out of 

10 times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

7 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

7 out of 7 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

12

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

12 out 

of 12 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

5

Deployments

 Type of Incident (number of CDC staff)18 Waterborne Illness (3)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

90

2008-09:

70

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Boise, ID: 75

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

10

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

7

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
70 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Illinois

idph.state.il.us/Bioterrorism/default.htm

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Illinois, 7.9% of adults 

reported having asthma, 8.3% diabetes, 6.2% heart disease, and 2.7% had a stroke. In 

addition, 18.2% reported a limiting disability and 63.3% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a 

COOP that included laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

3 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

3 out of 3 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

5 out of 5 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

111 

92%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

11

64%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY , 

which have two.

1 passed, 

1 did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Two

Level 3 

labs

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

Level 2 

lab:

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

Level 2 

lab: 

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Level 2 

lab: 

did not 

pass

Level 3 

labs:

 1 passed, 

1 did not 

participate

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Level 2 

lab: 

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

10 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

53% 

U.S. Department of HealtH anD HUman ServiceS

See separate fact sheet for Chicago-specific data. centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 71 Fact Sheets

2

Illinois

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. Also see separate fact sheet for Chicago-specific data.

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Collaborative Planning for Delivery 

of Essential Healthcare Services; 

Countermeasure and State Immunization 

Information Systems Integration

$578,000

$218,358

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

5 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

7

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

6 out of 7 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

5

Deployments

 Type of Incident (number of CDC staff)18 Neurological Illness (1); HIV by Organ Transplant (2)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

96

2008-09:

99

Cities Readiness Initiative (CRI) Metropolitan 

Statistical Area (MSA) and 2007-08 TAR score11

*Cohort I: Chicago, IL: 80; St. Louis, MO: 76

*Cohort II: No sites

*Cohort III: Peoria, IL: 59

See Scoring Note above. 

CRI MSAs can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the MSA 

was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

66

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

8

U.S. Department of HealtH anD HUman ServiceS

See separate fact sheet for Chicago-specific data. centerS for DiSeaSe control anD prevention
72 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Chicago

cityofchicago.org/city/en/depts/cdph/provdrs/emerg.html

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In Chicago, 7.5% of adults reported 

having asthma, 9.2% diabetes, 6.1% heart disease, and 2.7% had a stroke. In addition, 

16.4% reported a limiting disability and 64.3% were overweight or obese.* 

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

The lab located in Chicago is operated by the 

state of Illinois. See Illinois fact sheet.

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

Locality had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

—

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

The lab 

located in 

Chicago is 

operated 

by the 

state of 

Illinois. 

See Illinois 

fact sheet. 

Assessing if 

laboratory 

emergency 

contacts can be 

reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

—

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

—

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

—

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

—

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercise(s) to 

assess competency of sentinel 

laboratories to rule out 

bioterrorism agents1

—

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drills3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

—

Laboratories: Chemical Capabilities

Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

The lab 

located in 

Chicago is 

operated 

by the 

state of 

Illinois. 

See Illinois 

fact sheet. 

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

—

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

—

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

—

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

—

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

—

Response Readiness: Communication

Communicating

emerging 

health 

information

Locality public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

—

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

—

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

—

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7Locality data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

See separate fact sheet for 

Illinois state data.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 73 Fact Sheets

2

Chicago

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. Also see separate fact sheet for Illinois state data.

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of Illinois at Chicago - Illinois Public 

Health Preparedness Center $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Electronic Laboratory Data Exchange $619,172

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center 

staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: Locality must report 2 and 

could report up to 12 notifications.

8 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

3 out of 8 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: Locality must report 2 and 

could report up to 12 activations.

4 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

3 out of 4 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: Locality must report 2 and 

could report up to 12 AAR/IPs.

4 

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

4 out of 4 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

1

Deployments

 Type of Incident (number of CDC staff)18 MRSA Control Measures (2); Influenza (3)

Career Epidemiology Field Officers15 —

Quarantine Stations19 O’Hare International Airport, Chicago

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12See Illinois fact sheet for CDC TAR state scores 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

Cities Readiness Initiative (CRI) jurisdiction 2007-

2008 technical assistance review (TAR) score 11,12

City of Chicago: 94 

(part of Cohort 1, which was established in 2004)

Scoring Note: A score of 69 or higher indicates 

a CRI jurisdiction performed in an acceptable 

range in its plan to receive, distribute, and 

dispense medical assets. 

See appendix 6 for the average TAR score for 

the metropolitan statistical area of Chicago, IL, 

which has multiple contributing jurisdictions in 

addition to the City of Chicago.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

23

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

See separate fact sheet for 

Illinois state data.
74 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Indiana

in.gov/isdh/17855.htm

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Indiana, 9.2% of adults 

reported having asthma, 9.6% diabetes, 6.9% heart disease, and 2.8% had a stroke. In 

addition, 20.0% reported a limiting disability and 63.6% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

49 

69%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

2

50%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

10 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

42% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 75 Fact Sheets

2

Indiana

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Addressing Vulnerabilities in Populations;

Collaborative Planning for Delivery of 

Essential Healthcare Services

$275,000

$523,719

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 4 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

3 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

3 out of 3 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

4

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

4 out of 4 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

2

Deployments

 Type of Incident (number of CDC staff)18 Neurological Illness (4); Neuropathy (1)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

96

2008-09:

100

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Chicago, IL: 80

*Cohort II: Cincinnati, OH: 62; Indianapolis, IN: 83

*Cohort III: Louisville, KY: 68

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

38

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
76 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Iowa

ProtectIowaHealth.org

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Iowa, 7.7% of adults 

reported having asthma, 7.0% diabetes, 6.2% heart disease, and 2.7% had a stroke. In 

addition, 17.0% reported a limiting disability and 64.3% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

2 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 2 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

2 out of 2 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

77

22%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

2

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

131 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

68% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 77 Fact Sheets

2

Iowa

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of Iowa - Upper Midwest Center for 

Public Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Electronic Laboratory Data Exchange $258,978

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

2

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

4

Deployments

 Type of Incident (number of CDC staff)18 Iowa Floods (11); Disease Investigation (1); Histoplasmosis (3)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

93

2008-09:

95

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: Des Moines, IA: 54; Omaha, NE: 44

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

19

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
78 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Kansas

kdheks.gov/cphp

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Kansas, 8.7% of adults 

reported having asthma, 8.1% diabetes, 5.5% heart disease, and 2.5% had a stroke. In 

addition, 20.8% reported a limiting disability and 65.7% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

1 out of 2 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

20 

50%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Did not 

pass

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

No

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

18 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

65% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 79 Fact Sheets

2

Kansas

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

4

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

4 out of 4 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

7

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

93

2008-09:

94

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: Kansas City, MO: 73

*Cohort III: Witchita, KS: 59

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

13

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
80 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Kentucky

chfs.ky.gov/dph/epi/preparedness

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Kentucky, 9.7% of 

adults reported having asthma, 9.9% diabetes, 8.1% heart disease, and 3.6% had a stroke. 

In addition, 25.5% reported a limiting disability and 66.8% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

3 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

2 out of 3 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

80 

94%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

2

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 3 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

N/A

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

N/A

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

N/A

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

2 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

56% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 81 Fact Sheets

2

Kentucky

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

9

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

8 out of 9 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

6

Deployments

 Type of Incident (number of CDC staff)18 Hurricane Gustav (2); Influenza (3)

Career Epidemiology Field Officers15 2

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

86

2008-09:

83

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: Cincinnati, OH: 62

*Cohort III: Louisville, KY: 68

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

29

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

9

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
82 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Louisiana

dhh.louisiana.gov/offices/?ID=218

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In Louisiana, 8.0% of adults 

reported having asthma, 10.7% diabetes, 8.2% heart disease, and 3.8% had a stroke. In 

addition, 20.9% reported a limiting disability and 63.8% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

2 out of 2 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

2

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

4 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

3 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

70% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 83 Fact Sheets

2

Louisiana

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 Tulane University - South Central Center for 

Public Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Addressing Vulnerabilities in Populations $397,885

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

6 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

6 out of 6 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

5 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

5 out of 5 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

5 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

1

Deployments

 Type of Incident (number of CDC staff)18 Hurricane Ike (7); Hurricane Gustav (64); FEMA trailer-formaldehyde (27)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

94

2008-09:

100

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: No score

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

30

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
84 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Maine

maine.gov/dhhs/boh

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Maine, 10.3% of adults 

reported having asthma, 8.3% diabetes, 7.2% heart disease, and 2.8% had a stroke. In 

addition, 22.2% reported a limiting disability and 61.9% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

16 

50%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

5 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

1 out of 1 

method

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

0 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

59% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 85 Fact Sheets

2

Maine

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Electronic Death Reporting; 

Electronic Laboratory Data Exchange

$943,020

$508,567

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

5 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

3 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

3 out of 3 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

0

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

0 out of 0 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

12

Deployments

 Type of Incident (number of CDC staff)18 Pneumonia Cluster (3)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

51

2008-09:

90

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Portland, ME: 25

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

10

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
86 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Maryland

bioterrorism.dhmh.state.md.us

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Maryland, 9.4% of 

adults reported having asthma, 8.7% diabetes, 6.1% heart disease, and 2.6% had a stroke. 

In addition, 20.5% reported a limiting disability and 63.4% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

6 reference 

labs, 

2 national 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

6 out of 8 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

9 out of 9 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

22 

95%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

14

93%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

1 out of 1 

method

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

6 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

41% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 87 Fact Sheets

2

Maryland

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 Johns Hopkins University - Center for Public 

Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15

Johns Hopkins University, Baltimore - 

Preparedness to Address the Risks of 

Vulnerable Populations

$1,495,398

Advanced Practice Centers16 Montgomery County Advanced 

Practice Center $450,000

Centers of Excellence in Public Health Informatics17 Johns Hopkins University $1,145,675

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

5 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

2

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

9

Deployments

 Type of Incident (number of CDC staff)18

Salmonella Saintpaul (2); Hospital Infection Control (2); Dialysis Deaths (2); 

Acinetobacter Outbreak (2)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

93

2008-09:

96

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: National Capitol Region: 82; 

 Philadelphia, PA: 75

*Cohort II: Baltimore, MD: 77

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

36

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

2

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
88 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Massachusetts

mass.gov/dph/emergencyprep

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Massachusetts, 9.6% of 

adults reported having asthma, 7.2% diabetes, 5.5% heart disease, and 1.9% had a stroke. 

In addition, 17.5% reported a limiting disability and 58.1% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008 *Massachusetts experienced issues with CDC’s reporting system, which impacted this result.

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

2 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

2 out of 2 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

5 out of 5 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

83 

84%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

59

39%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

3 out of 3 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

1 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

126 

hours*

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

9 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

45% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 89 Fact Sheets

2

Massachusetts

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 Harvard University - Center for Public 

Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15

Harvard School of Public Health, Boston - 

Generate Criteria and Metrics to Measure 

Effectiveness and Efficiency

$1,717,286

Advanced Practice Centers16 Cambridge Advanced Practice Center $400,000

Centers of Excellence in Public Health Informatics17 Harvard Pilgrim Health Care, Inc. $1,467,018

Pandemic Influenza Promising Practices Demonstration Projects14 Electronic Laboratory Data Exchange;

Public Engagement

$384,889

$176,365

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

0 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

0 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

0 out of 0 

times

Conducted at least one 

unannounced activation14 No

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

7

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

6 out of 7 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

No

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

0

0

Deployments

 Type of Incident (number of CDC staff)18 Transplant Associated Virus (1)

Career Epidemiology Field Officers15 —

Quarantine Stations19 Logan International Airport, Boston

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

91

2008-09:

93

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Boston, MA: 76

*Cohort II: Providence, RI: 89

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

40

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

28

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
90 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Michigan

michigan.gov/mdch

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Michigan, 9.9% of 

adults reported having asthma, 9.1% diabetes, 6.7% heart disease, and 3.0% had a stroke. 

In addition, 22.6% reported a limiting disability and 64.7% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

9 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

9 out of 9 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

9 out of 9 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

95 

95%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

14

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

4 out of 4 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

75 hours

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

73 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

52% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 91 Fact Sheets

2

Michigan

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of Michigan - Center for Public 

Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Collaborative Planning for Delivery of 

Essential Healthcare Services;

Countermeasure and State Immunization 

Information Systems Integration;

Electronic Death Reporting

$997,324 

$300,000

$741,124

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 4 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

4 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

4 out of 4 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

4

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 4 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

7

Deployments

 Type of Incident (number of CDC staff)18 Measles Exposure (1)

Career Epidemiology Field Officers15 —

Quarantine Stations19 Detroit Metro Airport, Detroit

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

95

2008-09:

100

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Detroit, MI: 78

*Cohort II: No sites

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

67

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
92 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Minnesota

health.state.mn.us/oep

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Minnesota, 7.8% of 

adults reported having asthma, 5.9% diabetes, 6.1% heart disease, and 2.2% had a stroke. 

In addition, 19.9% reported a limiting disability and 62.8% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

2 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

2 out of 2 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

158 

98%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

22

95%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

3 out of 3 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

78 hours

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

24 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

49% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 93 Fact Sheets

2

Minnesota

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

5 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

8

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

8 out of 8 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

6

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 1

Quarantine Stations19 Minnesota-Saint Paul International Airport, Minneapolis

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

84

2008-09:

88

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Minneapolis, MN: 79

*Cohort II: No sites

*Cohort III: Fargo, ND: 70

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

34

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of Minnesota - Center for Public Health 

Preparedness $525,760

Preparedness and Emergency Response Research Centers15 University of Minnesota, Minneapolis $1,470,307

Advanced Practice Centers16 Twin Cities Metro Advanced Practice Center $400,000

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Countermeasure and Immunization Systems Integration; 

Delivery of Healthcare Services; 

Public Engagement; 

Distribution and Dispensing of Antiviral Drugs to 

Self-isolated/quarantined Persons; 

Electronic Laboratory Date Exchange

$299,992 

$872,249 

$161,524

$200,000

$680,343
94 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Mississippi

msdh.ms.gov

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In Mississippi, 7.0% of adults 

reported having asthma, 11.3% diabetes, 6.5% heart disease, and 4.0% had a stroke. In 

addition, 24.2% reported a limiting disability and 67.5% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

6 

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

15 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

61% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 95 Fact Sheets

2

Mississippi

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

9 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

8 out of 9 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

4 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

4 out of 4 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

11

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

8 out of 

11 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

—

—

Deployments

 Type of Incident (number of CDC staff)18

Hurricane Gustav (4); FEMA trailer - formaldehyde (6); Shigella Outbreak (2); 

HIV Investigation (2); Respiratory Illness (3); TB Outbreak (3); 

Infant Mortality (1); HIV Investigation (8)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

95

2008-09:

99

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Jackson, MS: 88; Memphis, TN: 72

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

14

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
96 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Missouri

dhss.mo.gov/BT_Response

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Missouri, 8.4% of adults 

reported having asthma, 9.1% diabetes, 7.2% heart disease, and 3.4% had a stroke. In 

addition, 25.0% reported a limiting disability and 65.5% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

123 

89%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

18 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

51% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 97 Fact Sheets

2

Missouri

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15

Saint Louis University - Saint Louis University 

Heartland Center for Public 

Health Preparedness

$525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

3 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

3 out of 3 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

4

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

4 out of 4 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

—

—

Deployments

 Type of Incident (number of CDC staff)18 Hemodialysis Reactions (1)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

96

2008-09:

89

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: St. Louis, MO: 76

*Cohort II: Kansas City, MO: 73

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

38

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

2

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
98 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Montana

dphhs.mt.gov/PHSD

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Montana, 9.6% of 

adults reported having asthma, 6.5% diabetes, 6.0% heart disease, and 2.8% had a stroke. 

In addition, 22.9% reported a limiting disability and 61.7% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

18 

67%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

85 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

73% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 99 Fact Sheets

2

Montana

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

3

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

3 out of 3 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

4

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

91

2008-09:

96

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Billings, MT: 80

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

8

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
100 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Nebraska

dhhs.ne.gov/emergency_preparedness

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Nebraska, 7.1% of 

adults reported having asthma, 7.8% diabetes, 5.8% heart disease, and 2.2% had a stroke. 

In addition, 18.3% reported a limiting disability and 64.1% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

2 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

2 out of 2 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

38 

76%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

2

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

104 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

57% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 101 Fact Sheets

2

Nebraska

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Addressing Vulnerabilities in Populations 

(2 Projects);

Electronic Laboratory Data Exchange 

(2 Projects);

Public Engagement

$215,000 and $270,000

$103,887 and $222,513

$162,995

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

3 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

5 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

5 out of 5 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

3

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

3 out of 3 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

5

Deployments

 Type of Incident (number of CDC staff)18 Neurological Illness (1)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

81

2008-09:

85

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Omaha, NE: 44

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

12

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
102 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Nevada

health.nv.gov

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Nevada, 8.6% of adults 

reported having asthma, 8.6% diabetes, 6.3% heart disease, and 2.2% had a stroke. In 

addition, 20.3% reported a limiting disability and 62.6% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

2 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

2 out of 2 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

6 out of 6 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

13

77%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

5

60%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

1 out of 1 

method

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

0 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

64% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 103 Fact Sheets

2

Nevada

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 4 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

8 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

7 out of 8 

times

Conducted at least one 

unannounced activation14

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

8 

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

8 out of 8 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

—

—

Deployments

 Type of Incident (number of CDC staff)18

Ricin Incident (2); Hepatitis C Infections (3); Strep Infections (2); 

TB Outbreak (3); Hepatitis C Infections (2)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review 

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08: 

55

2008-09: 

89

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Las Vegas, NV: 82 

*Cohort II: No sites 

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

15 

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

No 
104 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

New Hampshire

dhhs.state.nh.us/dhhs/cdcs/ppcc.htm

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In New Hampshire, 10.4% of adults 

reported having asthma, 7.2% diabetes, 5.7% heart disease, and 2.4% had a stroke. In 

addition, 21.4% reported a limiting disability and 63.1% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

15 

67%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

7

71%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

100 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

58% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 105 Fact Sheets

2

New Hampshire

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Collaborative Planning for Delivery of 

Essential Healthcare Services $864,497

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

5 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

3 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

3 out of 3

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

4

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

3 out of 4 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

No

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

6

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

86

2008-09:

81

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Boston, MA: 76

*Cohort II: No sites

*Cohort III: Manchester, NH: 75

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

10

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
106 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

New Jersey

state.nj.us/health/er

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In New Jersey, 8.6% of 

adults reported having asthma, 8.4% diabetes, 6.2% heart disease, and 2.3% had a stroke. 

In addition, 17.1% reported a limiting disability and 62.1% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

108

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

405 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

61% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 107 Fact Sheets

2

New Jersey

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15

University of Medicine and Dentistry of New 

Jersey - New Jersey Center for Public Health 

Preparedness at UMDNJ

$525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

12 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

12 out of 

12 times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

12 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

12 out of 

12 times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

3

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

1 out of 3 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

4

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 Newark Liberty International Airport, Newark

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

98

2008-09:

100

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: New York City, NY: 86; 

 Philadelphia, PA: 75

*Cohort II: No sites

*Cohort III: Trenton, NJ: 78

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

58

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
108 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

New Mexico

health.state.nm.us/ohem

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In New Mexico, 8.5% of 

adults reported having asthma, 7.9% diabetes, 5.5% heart disease, and 2.6% had a stroke. 

In addition, 22.2% reported a limiting disability and 59.9% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

12 

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

pass

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

4 out of 4 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

71 hours

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

No

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

34 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

51% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 109 Fact Sheets

2

New Mexico

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Electronic Laboratory Data Exchange $532,853

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

1 time 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

1 out of 1 

time

Conducted at least one 

unannounced notification outside 

of normal business hours14

No

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

4 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

4 out of 4 

times

Conducted at least one 

unannounced activation14 No

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

4

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

4 out of 4 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

No

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

6

Deployments

 Type of Incident (number of CDC staff)18 Strep Infections (3)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

71

2008-09:

78

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Albuquerque, NM: 26

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

12

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
110 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

New York

health.state.ny.us/environmental/emergency

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In New York, 8.8% of 

adults reported having asthma, 8.4% diabetes, 5.6% heart disease, and 2.6% had a stroke. 

In addition, 19.4% reported a limiting disability and 60.3% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008 

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a 

COOP that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

5 reference 

labs 

(includes 

NYC)

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

5 out of 

5 labs 

(includes 

NYC)

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

13 out of 

13 tests 

(includes 

NYC)

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

129 

73%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

40

78%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Both 

passed 

(includes 

NYC)

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

One 

Level 3 

lab (NYC)

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

Level 1 

lab:

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

Level 1 

lab:

4 out of 4 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Level 1 

lab:

passed

Level 3 

lab (NYC):

passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Level 1 

lab:

1 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

Level 1 

lab:

73 hours

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

59 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

41% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

Laboratory data includes New York City (NYC); 

see separate fact sheet for NYC-specific data.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 111 Fact Sheets

2

New York

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. Also see separate fact sheet for New York City-specific data. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15

University of Albany, State University of 

New York-University at Albany Center for 

Public Health Preparedness

$525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 Western New York Public Health Alliance, Inc. 

Advanced Practice Center $350,000

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

3 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

3 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

3 out of 3 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

4

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 4 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

18

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

97

2008-09:

100

Cities Readiness Initiative (CRI) Metropolitan 

Statistical Area (MSA) and 2007-08 TAR score11

*Cohort I: New York City, NY: 86

*Cohort II: No sites

*Cohort III: Albany, NY: 92; Buffalo, NY: 85

See Scoring Note above. 

CRI MSAs can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the MSA 

was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

94

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

9

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

Laboratory data includes New York City (NYC); 

see separate fact sheet for NYC-specific data.
112 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

New York City

nyc.gov/html/doh/html/bt/bt.shtml

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In New York City, 7.5% of adults 

reported having asthma, 6.9% diabetes, 4.7% heart disease, and 2.4% had a stroke. In 

addition, 17.4% reported a limiting disability and 55.0% were overweight or obese.* 

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

No data collected

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

Locality had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts can be 

reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

—

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

— 

—

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercise(s) to 

assess competency of sentinel 

laboratories to rule out 

bioterrorism agents1

—

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drills3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

Participation 

in Laboratory 

Response 

Network for 

chemical agents 

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 3 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

N/A

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

N/A

Assessing 

LRN-C 

laboratory 

capabilities 

through 

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

N/A

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating 

emerging 

health 

information

Locality public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

—

Public health laboratory 

used HAN or other rapid 

method (blast email or 

fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

—

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

—

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7Locality data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

See separate fact sheet for 

New York state data.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 113 Fact Sheets

2

New York City

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. Also see separate fact sheet for New York state data.

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 Columbia University - Mailman Center for 

Public Health $525,674

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 New York City Department of Health and 

Mental Hygiene $930,959

Pandemic Influenza Promising Practices Demonstration Projects14

Collaborative Planning for Delivery 

of Essential Healthcare Services; 

Countermeasure and State Immunization 

Information Systems Integration

$850,681 

$387,082

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center 

(EOC) staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: Locality must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 4 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: Locality must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: Locality must report 2 and 

could report up to 12 AAR/IPs.

2 

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

3

8

Deployments

 Type of Incident (number of CDC staff)18 Bacillus Infections (3)

Career Epidemiology Field Officers15 2

Quarantine Stations19 JFK International Airport, New York City

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12See New York State fact sheet for CDC TAR state scores 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

Cities Readiness Initiative (CRI) jurisdiction 2007-

2008 technical assistance review (TAR) score11,12

New York City: 99 

(part of Cohort 1, which was established in 2004)

Note: A score of 69 or higher indicates a CRI 

jurisdiction performed in an acceptable range 

in its plan to receive, distribute, and dispense 

medical assets. 

See appendix 6 for the average TAR score for the 

metropolitan statistical area of New York City, NY, 

which has multiple contributing jurisdictions in 

addition to New York City.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

55 

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention

See separate fact sheet for 

New York state data.
114 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

North Carolina

epi.state.nc.us/epi/phpr

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In North Carolina, 7.6% of 

adults reported having asthma, 9.3% diabetes, 6.2% heart disease, and 3.0% had a stroke. 

In addition, 21.3% reported a limiting disability and 65.7% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

5 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

5 out of 5 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

11 out of 

12 tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

35

89%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

14

57%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

pass

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

115 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

52% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 115 Fact Sheets

2

North Carolina

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of North Carolina - Center for 

Public Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15

University of North Carolina, Chapel 

Hill - Create and Maintain Sustainable 

Preparedness and Response Systems

$1,695,189

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

5 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

1

Deployments

 Type of Incident (number of CDC staff)18

Hurricane Gustav (1); Salmonella Saintpaul (3); Hospital Infection Control (1); 

Hepatitis C Infections (1)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

93

2008-09:

98

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: Virginia Beach, VA: 86

*Cohort III: Charlotte, NC: 63

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

57

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
116 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

North Dakota

ndhealth.gov/epr

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In North Dakota, 7.9% of 

adults reported having asthma, 7.6% diabetes, 5.6% heart disease, and 2.4% had a stroke. 

In addition, 17.0% reported a limiting disability and 67.4% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008 *North Dakota elected to acquire elemental analysis capabilities reflected in only three core methods.

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

7

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab*

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

3 out of 6 

methods*

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods*

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

7 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

69% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 117 Fact Sheets

2

North Dakota

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Countermeasure and State Immunization 

Information Systems Integration $180,348

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

2

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

—

—

Deployments

 Type of Incident (number of CDC staff)18 Wild Game Contamination (3); Resistant Meningococcus (2)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

77

2008-09:

83

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Fargo, ND: 70

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

6

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
118 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Ohio

prepareohio.com

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Ohio, 9.6% of adults 

reported having asthma, 9.9% diabetes, 7.2% heart disease, and 2.9% had a stroke. In 

addition, 21.5% reported a limiting disability and 63.4% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

2 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

2 out of 2 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

114 

97%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

14

93%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 3 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

N/A

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

N/A

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

N/A

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

4 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

55% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 119 Fact Sheets

2

Ohio

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 The Ohio State University - Ohio Center for 

Public Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Public Engagement $144,120

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

5 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

3 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

3 out of 3 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

5 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

4

Deployments

 Type of Incident (number of CDC staff)18 Burkholderia (1)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

90

2008-09:

89

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Cleveland, OH: 71

*Cohort II: Cincinnati, OH: 62; Columbus, OH: 52

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

76

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
120 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Oklahoma

ok.gov/health/

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In Oklahoma, 8.9% of adults 

reported having asthma, 10.1% diabetes, 7.9% heart disease, and 4.1% had a stroke. In 

addition, 26.1% reported a limiting disability and 66.6% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

29 

97%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

6

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

No

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 3 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

N/A

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

N/A

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

N/A

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

10 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

64% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 121 Fact Sheets

2

Oklahoma

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of Oklahoma - Southwest Center 

for Public Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

1 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

9

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

4 out of 9 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

6

Deployments

 Type of Incident (number of CDC staff)18 Infection Control (1); E. coli Infections (3)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

97

2008-09:

98

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Oklahoma City, OK; 79

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

24

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
122 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Oregon

oregon.gov/DHS/ph/preparedness

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Oregon, 8.6% of adults 

reported having asthma, 6.9% diabetes, 5.4% heart disease, and 2.4% had a stroke. In 

addition, 23.9% reported a limiting disability and 61.7% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

53

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 3 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

N/A

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

N/A

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

N/A

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

16 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

61% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 123 Fact Sheets

2

Oregon

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Addressing Vulnerabilities in Populations; 

Collaborative Planning for Delivery of 

Essential Health Services;

Electronic Laboratory Data Exchange

$260,371

$1,034,334 

$251,453

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

3 out of 4 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 No

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

3

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

3 out of 3

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

5

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

85

2008-09:

86

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: Portland, OR: 58

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

23

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
124 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Pennsylvania

dsf.health.state.pa.us

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Pennsylvania, 9.3% of 

adults reported having asthma, 8.8% diabetes, 7.2% heart disease, and 2.6% had a stroke. 

In addition, 21.1% reported a limiting disability and 64.4% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

2 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

77 

81%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

13

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

2 out of 2 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

6 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

55% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 125 Fact Sheets

2

Pennsylvania

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of Pittsburgh - Center for Public 

Health Practice $525,760

Preparedness and Emergency Response Research Centers15

University of Pittsburgh - Create and Maintain 

Sustainable Preparedness and 

Response Systems

$1,701,845

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Addressing Population Vulnerabilities; 

Distribution and Dispensing of Antiviral 

Drugs to Self-isolated/quarantined Persons

$310,000

$140,753

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

2

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

3

22

Deployments

 Type of Incident (number of CDC staff)18 Hepatitis B Infections (2)

Career Epidemiology Field Officers15 3

Quarantine Stations19 Philadelphia International Airport, Philadelphia

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

60

2008-09:

82

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: New York City, NY: 86; 

 Philadelphia, PA: 75; Pittsburgh, PA: 42

*Cohort II: No sites

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

82

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

2

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
126 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Rhode Island

www.health.ri.gov/cepr

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Rhode Island, 10.6% of 

adults reported having asthma, 7.4% diabetes, 6.1% heart disease, and 2.3% had a stroke. 

In addition, 18.9% reported a limiting disability and 60.0% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

7 

71%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

2 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

40 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

63% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 127 Fact Sheets

2

Rhode Island

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Addressing Vulnerabilities in Populations; 

Electronic Laboratory Data Exchange

$370,000

 $303,415

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 4 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

0

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

0 out of 0 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

—

—

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

93

2008-09:

99

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: Providence, RI: 89

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

8

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
128 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

South Carolina

scdhec.net/administration/ophp

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In South Carolina, 8.3% of adults 

reported having asthma, 10.1% diabetes, 6.4% heart disease, and 3.2% had a stroke. In 

addition, 21.7% reported a limiting disability and 65.9% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

22 

86%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

7

29%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

4 out of 4 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Did not 

pass

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

0 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

100

hours

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

4 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

79% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 129 Fact Sheets

2

South Carolina

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of South Carolina - Center for 

Public Health Preparedness $525,760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

4 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 4 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

1 time

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

1 out of 1 

time

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

8

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

8 out of 8 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

8

Deployments

 Type of Incident (number of CDC staff)18 TB Outbreak (4)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

87

2008-09:

93

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Charlotte, NC; 63; Columbia, SC: 83

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

27

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
130 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

South Dakota

doh.sd.gov

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In South Dakota, 7.2% of 

adults reported having asthma, 6.6% diabetes, 6.6% heart disease, and 2.7% had a stroke. 

In addition, 19.0% reported a limiting disability and 64.9% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

49 

43%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

4 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

18 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

64% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 131 Fact Sheets

2

South Dakota

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

No

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

1 time

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

1 out of 1 

time

Conducted at least one 

unannounced activation14 No

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

2

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

—

—

Deployments

 Type of Incident (number of CDC staff)18 Suicides (4)

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

87

2008-09:

91

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Sioux Falls, SD: 74

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

8

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
132 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Tennessee

health.state.tn.us/ceds/bioterrorism.htm

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or locality 

must consider the unique needs of its own population. In Tennessee, 9.0% of adults 

reported having asthma, 10.4% diabetes, 8.4% heart disease, and 3.4% had a stroke. In 

addition, 22.8% reported a limiting disability and 68.0% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

4 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

4 out of 4 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

10 out of 

11 tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

55 

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

14

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

3 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

 Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

14 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

62% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 133 Fact Sheets

2

Tennessee

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

2 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

1 time

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

1 out of 1 

time

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

5 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

3

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

89

2008-09:

89

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Memphis, TN: 72; Nashville, TN: 56

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

38

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
134 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Texas

dshs.state.tx.us/preparedness

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Texas, 7.3% of adults 

reported having asthma, 9.7% diabetes, 6.1% heart disease, and 2.5% had a stroke. In 

addition, 19.2% reported a limiting disability and 66.2% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

14 

reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

11 out of 

14 labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

23 out of 

25 tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

74 

89%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

36

86%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

pass 

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

7 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

44% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 135 Fact Sheets

2

Texas

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15

Texas A & M - Center for Rural 

Public Health Preparedness;

University of Texas - Center for Biosecurity 

and Public Health Preparedness

$525,760

 $525, 760

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 Tarrant County Advanced Practice Center $450,000

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 Electronic Laboratory Data Exchange $799,798

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

1 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

0 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

0 out of 0 

times

Conducted at least one 

unannounced activation14 No

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

7

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

7 out of 7 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

7

Deployments

 Type of Incident (number of CDC staff)18

Hurricane Ike (61); Hurricane Gustav (12); Tropical Storm Dolly (1); 

Hemodialysis Reactions (3); Salmonella (7); Cryptosporidiosis (2); Typhus (2); 

Infusion Center Infections (1)

Career Epidemiology Field Officers15 —

Quarantine Stations19 DFW International Airport, Dallas; George Bush Intercontinental Airport, 

Houston; Sunland Park Drive, El Paso

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

97

2008-09:

100

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Dallas, TX: 91; Houston, TX: 79

*Cohort II: San Antonio, TX: 55

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

140

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

2

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
136 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Utah

health.utah.gov

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Utah, 8.4% of adults 

reported having asthma, 6.1% diabetes, 4.9% heart disease, and 2.0% had a stroke. In 

addition, 19.5% reported a limiting disability and 58.2% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

34 

94%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

2

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

4 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

13 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

59% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 137 Fact Sheets

2

Utah

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 University of Utah $1,276,079

Pandemic Influenza Promising Practices Demonstration Projects14 Electronic Death Reporting $281,117

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

5 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

2

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

1 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

3

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

85

2008-09:

88

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Salt Lake City, UT: 68

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

16

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
138 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Vermont

healthvermont.gov/e_ready.aspx

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Vermont, 9.9% of 

adults reported having asthma, 6.4% diabetes, 5.8% heart disease, and 2.1% had a stroke. 

In addition, 21.3% reported a limiting disability and 58.5% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State had a COOP that included 

laboratory operations

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

3 out of 3 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

8

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

3

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

1 out of 1 

method

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

0 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

3 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

36% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 139 Fact Sheets

2

Vermont

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

2 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

1 out of 2 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

2

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

1 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

3

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

93

2008-09:

98

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Burlington, VT: 70

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

6

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
140 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Virginia

vdh.state.va.us/epr

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Virginia, 9.3% of adults 

reported having asthma, 7.9% diabetes, 5.9% heart disease, and 2.6% had a stroke. In 

addition, 19.3% reported a limiting disability and 61.6% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

4 out of 4

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

83

98%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

17

94%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

4 out of 4 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

103 hours 

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

13 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

39% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 141 Fact Sheets

2

Virginia

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14

Addressing Vulnerabilities in Populations; 

Collaborative Planning for Delivery of 

Essential Healthcare Services

$365,000

$1,000,000

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

3 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

2

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 2 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

13

Deployments

 Type of Incident (number of CDC staff)18 Vaccinia Virus Infection (2)

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

100

2008-09:

100

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: National Capitol Region: 82

*Cohort II: Virginia Beach, VA: 86

*Cohort III: Richmond, VA: 89

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

50

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

1

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
142 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Washington

doh.wa.gov/phepr

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Washington, 9.3% of 

adults reported having asthma, 6.9% diabetes, 4.8% heart disease, and 2.3% had a stroke. 

In addition, 23.9% reported a limiting disability and 61.8% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

6 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

5 out of 6 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

7 out of 8 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

72 

96%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

6

83%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

20 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

51% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 143 Fact Sheets

2

Washington

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 University of Washington - Northwest Center 

for Public Health Practice $525,760

Preparedness and Emergency Response Research Centers15

University of Washington, Seattle - Improve 

Communications in Preparedness 

and Response

$1,270,632

Advanced Practice Centers16 Seattle-King County Advanced 

Practice Center $450,000

Centers of Excellence in Public Health Informatics17 University of Washington $1,274,502

Pandemic Influenza Promising Practices Demonstration Projects14 Public Engagement $180,699

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

4 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

4 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

4 out of 4 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

3

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

2 out of 3 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

3

6

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 Seattle-Tacoma International Airport, Seattle

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

94

2008-09:

97

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Seattle, WA: 68

*Cohort II: Portland, OR: 58

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

40

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

2

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
144 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

West Virginia

wvdhhr.org/healthprep

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People with 

chronic conditions may require additional care such as specialized medications, equipment, 

and other assistance. To develop an effective response plan, a state or locality must consider 

the unique needs of its own population. In West Virginia, 9.6% of adults reported having 

asthma, 11.9% diabetes, 11.5% heart disease, and 4.3% had a stroke. In addition, 29.5% 

reported a limiting disability and 68.8% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

1 out of 1 

test

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

2 

0%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

pass

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 2 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

4 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

0 out of 0 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

Not 

eligible

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

0 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

50% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 145 Fact Sheets

2

West Virginia

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

3 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

2 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

2 out of 2 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

7

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

6 out of 7 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

2

3

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

61

2008-09:

83

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: National Capitol Region: 82

*Cohort II: No sites

*Cohort III: Charleston, WV: 50

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

14

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
146 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Wisconsin

dhfs.wisconsin.gov/preparedness

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Wisconsin, 9.4% of 

adults reported having asthma, 7.2% diabetes, 6.4% heart disease, and 2.1% had a stroke. 

In addition, 18.2% reported a limiting disability and 63.6% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

State public health laboratory had a COOP 

that was tested

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

3 reference 

labs

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

3 out of 3 

labs

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

6 out of 6 

tests

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

133 

94%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

7

100%

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Passed

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 1 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

6 out of 6 

methods

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

4 out of 4 

methods

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

2 out of 2 

agents

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

122 hours

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

60 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

55% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 147 Fact Sheets

2

Wisconsin

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

5 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

5 out of 5 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

5 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

5 out of 5 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

6

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

6 out of 6 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

4

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 —

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

86

2008-09:

92

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: Chicago, IL: 80; Minneapolis, MN: 79

*Cohort II: Milwaukee, WI: 79

*Cohort III: No sites

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

37

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

14

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
148 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Fact Sheets

2

Wyoming

wdh.state.wy.us/sho/hazards

All response begins at the local level. Being prepared 

to prevent, respond to, and recover from all types of 

public health threats requires that states and localities 

improve their capabilities in surveillance, epidemiology, 

laboratories, and response readiness. Facts on 

laboratories and response readiness activities appear 

below. See appendices 1 and 7 for a more detailed 

description of data points and data sources.

A healthy population is more resilient in public health emergencies. People 

with chronic conditions may require additional care such as specialized medications, 

equipment, and other assistance. To develop an effective response plan, a state or 

locality must consider the unique needs of its own population. In Wyoming, 9.2% of 

adults reported having asthma, 7.4% diabetes, 5.7% heart disease, and 2.2% had a stroke. 

In addition, 20.6% reported a limiting disability and 62.1% were overweight or obese.*

*CDC, ONCDIEH (NCCDPHP) Behavioral Risk Factor Surveillance System, 2008

1

APHL; 2008 2CDC, OSELS; 2008 3CDC, OID (NCEZID); 2008 4CDC, OPHPR (DSLR); 2008 5CDC, ONDIEH (NCEH); 2009 6CDC, ONDIEH (NCEH); 2008 7State data; 2008 8

CDC, OPHPR (DEO); 2009 9CDC, OPHPR (DEO); 2008

Laboratories: General

Maintaining 

core laboratory 

functions during 

an emergency 

Status of continuity of operations plan (COOP):1

COOP was under development

Ensuring 

availability of 

Laboratory 

Response 

Network (LRN) 

laboratory 

results for 

decision making

State had a standardized 

electronic data system 

capable of messaging 

laboratory results between 

LRN laboratories and also 

to CDC2

Note: For a description of LRN 

laboratories, see appendix 1.

Yes

Laboratories: Biological Capabilities

Participation 

in LRN for 

biological 

agents

LRN reference and/or national 

laboratories that could test for 

biological agents3

1 reference 

lab

Assessing if 

laboratory 

emergency 

contacts could 

be reached 24/7

LRN laboratories successfully 

contacted during a nonbusiness hours telephone drill3

1 out of 1 

lab

Evaluating 

LRN laboratory 

capabilities

Proficiency tests passed by 

LRN reference and/or national 

laboratories3

1 out of 1 

test

Rapid 

identification 

of diseasecausing bacteria 

by PulseNet 

laboratories

Rapidly identified E. coli

O157:H7 using advanced DNA 

tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

8 

100%

Rapidly identified 

L. monocytogenes using 

advanced DNA tests (PFGE)4

 Samples for which state 

performed tests 

 Test results submitted to 

PulseNet database within 4 

working days (target: 90%)

—

N/A

Assessing 

laboratory 

competency 

and reporting 

through 

exercises

State public health laboratory 

conducted exercises to assess 

competency of sentinel 

laboratories to rule out 

bioterrorism agents1

Yes

CDC-funded LRN laboratory 

ability to contact the CDC 

Emergency Operations Center 

within 2 hours during LRN 

notification drill3

Note: There is one CDCfunded LRN laboratory in DC 

and in each state, with the 

exception of CA, IL, and NY, 

which have two.

Did not 

participate

Laboratories: Chemical Capabilities

 Participation 

in Laboratory 

Response 

Network for 

chemical agents

(LRN-C) 

LRN-C laboratories with 

capabilities for responding 

if the public is exposed to 

chemical agents5

Note: There are three levels, 

with Level 1 having the most 

advanced capabilities. See 

appendix 1.

One 

Level 3 

lab

Evaluating 

LRN-C 

laboratory 

capabilities 

through 

proficiency 

testing

Core methods successfully 

demonstrated by Level 1 

and/or Level 2 laboratories 

to rapidly detect chemical 

agents5

N/A

Additional methods 

successfully demonstrated 

by Level 1 and/or Level 2 

laboratories to rapidly detect 

chemical agents5

N/A

Assessing 

LRN-C 

laboratory 

capabilities 

through

exercises

LRN-C laboratory ability to 

collect, package, and ship 

samples properly during LRN 

exercise5

Passed

Chemical agents detected 

by Level 1 and/or Level 2 

laboratories in unknown 

samples during the LRN 

Emergency Response Pop 

Proficiency Test (PopPT) 

Exercise6

N/A

Hours to process and report 

on 500 samples by Level 1 

laboratory during the LRN 

Surge Capacity Exercise 

(range was 71 to 126 hours)5

N/A

Response Readiness: Communication

Communicating

emerging 

health 

information

State public health 

department had a 24/7 

reporting capacity system 

that could receive urgent 

disease reports any time of 

the day7

Yes

Responded to Health Alert 

Network (HAN) test message 

within 30 minutes8

Yes

State public health 

laboratory used HAN or 

other rapid method (blast 

email or fax) to communicate 

with sentinel laboratories 

and other partners for 

outbreaks, routine updates, 

training events, and other 

applications1

262 times

Epidemic Information 

Exchange users responded to 

system-wide notification test 

within 3 hours9

54% 

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 149 Fact Sheets

2

Wyoming

In addition to the activities listed above, CDC supported other projects and activities to enhance preparedness efforts. Snapshots of these 

CDC efforts are provided below. 

Research, Training, Education, and Promising Demonstration Projects

Project Location/Project Name Amount

Centers for Public Health Preparedness15 — N/A

Preparedness and Emergency Response Research Centers15 — N/A

Advanced Practice Centers16 — N/A

Centers of Excellence in Public Health Informatics17 — N/A

Pandemic Influenza Promising Practices Demonstration Projects14 — N/A

Response Readiness: Exercises and Incidents

Notifying 

emergency 

operations 

center staff

Pre-identified staff notified to fill all 

eight Incident Command System 

core functional roles due to a drill, 

exercise, or real incident14 

Note: State must report 2 and 

could report up to 12 notifications.

3 times 

Pre-identified staff acknowledged 

notification within the target time 

of 60 minutes14

3 out of 3 

times

Conducted at least one 

unannounced notification outside 

of normal business hours14

Yes

Activating 

the emergency 

operations 

center (EOC)

Public health EOC activated as part 

of a drill, exercise, or real incident14

Note: State must report 2 and 

could report up to 12 activations.

4 times

Pre-identified staff reported to 

the public health EOC within the 

target time of 2.5 hours14

4 out of 4 

times

Conducted at least one 

unannounced activation14 Yes 

Response Readiness: Evaluation

Assessing 

response 

capabilities 

through after 

action report/ 

improvement 

plans (AAR/IPs)

AAR/IPs developed following an 

exercise or real incident14

Note: State must report 2 and 

could report up to 12 AAR/IPs.

5

AAR/IPs

AAR/IPs developed within target 

time of 60 days14

5 out of 5 

AAR/IPs

Re-evaluated response capabilities 

following approval and completion 

of corrective actions identified in 

AAR/IPs14

Yes

Additional CDC Resources Supporting Preparedness in States and Localities

Epidemic Intelligence Service

 Epidemic Intelligence Service Field Officers17

 Investigations conducted by Epidemic Intelligence 

Service Field Officers17

1

13

Deployments

 Type of Incident (number of CDC staff)18 —

Career Epidemiology Field Officers15 1

Quarantine Stations19 —

14CDC, OPHPR (DSLR); 2008 15CDC, OPHPR (OD); 2008 16NACCHO; 2008 17CDC, OSELS; 2008 18CDC, OPHPR (DEO); 2008 19CDC, OID (NCEZID); 2008

10CDC, OSTLTS; 2008 11CDC, OPHPR (DSNS); 2008 12CDC, OPHPR (DSNS); 2009 13NACCHO; 2008 14CDC, OPHPR (DSLR); 2008

Response Readiness: Communication (continued)

Improving 

public health 

information 

exchange

Participated in a Public Health 

Information Network forum 

(community of practice) to 

leverage best practices for 

information exchange10

Yes

Response Readiness: Planning

Assessing 

plans to 

receive, 

distribute, 

and dispense 

medical 

assets from 

the Strategic 

National 

Stockpile and 

other sources

CDC technical assistance review

(TAR) state score 11, 12

Scoring Note: A score of 69 or 

higher indicates performance in 

an acceptable range in plans to 

receive, distribute, and dispense 

medical assets.

2007-08:

80

2008-09:

80

Cities Readiness Initiative (CRI) location and 

2007-08 TAR score11

*Cohort I: No sites

*Cohort II: No sites

*Cohort III: Cheyenne, WY: 49

See Scoring Note above. 

CRI locations can consist of multiple jurisdictions, 

some located in more than one state. See 

appendix 6.

*Cohort I, II or III refers to the year when the 

location was added to CRI. See appendix 1.

Enhancing 

response 

capability 

for chemical 

events

CHEMPACK nerve-agent antidote 

containers11

5

Meeting 

preparedness 

standards for 

local health 

departments

Local health departments 

meeting voluntary Project Public 

Health Ready preparedness 

standards13

0

U.S. Department of HealtH anD HUman ServiceS

centerS for DiSeaSe control anD prevention
150 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State U.S. Insular Areas

2

Overview of Preparedness in the U.S. Insular 

Areas: Territories, Commonwealths, 

and Freely Associated States

Puerto Rico

U.S. Virgin Islands

Guam

American Samoa

Northern 

Mariana 

Islands

Federated 

States of 

Micronesia

Republic of the 

Marshall Islands

Republic

 of Palau

Micronesia residents queue up to receive 

H1N1 vaccines in fall 2009. Public health 

workers traveled for two weeks by boat to 

deliver the first vaccine shipments to the 

dispersed islands.

Photo source: Ministry of Health, Yap, Federated 

States of Micronesia

The United States has strategic and economic pacts with two jurisdictions 

in the Atlantic Ocean and six in the Pacific 

Basin. Jointly referred to as insular areas, 

they include territories, commonwealths, and 

freely associated states. The pacts between 

the United States and these islands include 

the provision of federal assistance. CDC’s 

Public Health Emergency Preparedness 

(PHEP) cooperative agreement provides 

funding for preparedness activities to health 

departments on these islands, many of which 

face diverse challenges related to their isolated 

geographical locations and socioeconomic 

conditions. 

The U.S. insular areas receiving PHEP 

preparedness funding are the territories 

of American Samoa, Guam, and U.S. Virgin 

Islands; the commonwealths of the Northern 

Mariana Islands and Puerto Rico; and the three
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 151 U.S. Insular Areas

2

H1N1

Guam Responds to the 2009 H1N1 Influenza Pandemic

The 2009 H1N1 influenza pandemic provided a real world opportunity for Guam to 

activate its plans to receive medical assets from CDC’s Strategic National Stockpile. 

Guam has limited laboratory capacity for confirming infectious diseases such as 

H1N1 pandemic influenza, but plans to increase that capacity. In the future, Guam 

may be able to serve as a reference laboratory for the broader Pacific region as well as 

its own growing population. Guam’s population is expected to increase exponentially 

with the planned relocation of 40,000 U.S. Marines and their dependents from 

Okinawa to Guam, where the central U.S. military base in the Pacific is located.

Source: CDC, Office of Public Health Preparedness and Response, Division of State and Local Readiness (2009)

freely associated states of the Federated States 

of Micronesia, the Republic of the Marshall 

Islands, and the Republic of Palau.47 

These areas also received funding specifically 

for pandemic influenza preparedness through 

the pandemic influenza supplement in 2006-

2008 and, more recently, through the Public 

Health Emergency Response grant in response 

to the 2009 H1N1 influenza pandemic. 

Preparedness Challenges and Focus

Public health preparedness efforts in the 

insular areas differ from the U.S. mainland due 

to their isolation. Methods for communicating 

about preparedness range from word of 

mouth and distributing flyers door-to-door 

to the use of telephones, cell phones with 

solar chargers, and HAM radios. Internet 

connectivity is limited and costly. PHEP funds 

are used primarily for building and maintaining 

basic capabilities. The current focus is on 

obtaining equipment, planning, and exercising 

emergency response plans, with some 

emphasis on training.

A Range of Surveillance Systems

Disease surveillance and reporting methods 

in the islands range from well developed, 

electronic systems connected to CDC’s secure 

Epidemic Information Exchange (Epi-X) 

system and the Health Alert Network (HAN) 

to more basic, paper-based systems that can 

be effective in smaller, more remote island 

communities where electricity may not be 

available. As of July 2009, Guam, the Northern 

Mariana Islands, Puerto Rico, and the U.S. 

Virgin Islands all responded to HAN test 

messages within the target time of 30 minutes. 

The ability of public health staff to receive 

urgent emerging health information helps 

ensure that local problems are contained and 

national events are detected sooner. 

Limited Laboratory Capability

Laboratory capability – the ability to analyze 

biological and chemical specimens – is very 

limited in the islands. Challenges include large 

travel distances, slow or little communication 

between the islands, difficulties in transporting 

specimens, and lack of training and resources. 

Another important challenge is the lack of 

physical infrastructure to support laboratory 

requirements such as controlled environments 

and stable power sources. Most of the islands 

send specimens for confirmatory testing to 

reference laboratories in the United States and 

Australia, a practice that is time-consuming; 

receiving results can take from a week to more 

than a month. 

Improved Planning for Emergencies

PHEP cooperative agreement funding has been 

instrumental in supporting the development 

and exercising of emergency response plans 

for all insular areas. This has resulted in greater 

preparedness of the public health workforce as 

well as the communities they serve. H1N1
152 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State U.S. Insular Areas

2

As with states and localities, insular areas 

receiving PHEP funding are required to report 

on exercising and improving their response 

plans. Table 10 presents FY 2008 data submitted 

by the eight U.S. insular areas. (For a fuller 

explanation of these data points, see appendix 1.) 

Table 10: Public Health Preparedness Activities in U.S. Insular Areas; 2007-2008

Activating the Emergency Operations Center

(EOC) Notifying Emergency Operations Center Staff Assessing Response Capabilities through After Action Reports/Improvement Plans (ARR/IPs)

EOC activated 

as part 

of a drill, 

exercise, or 

real incident* 

Preidentified 

staff 

reported 

to the EOC 

within the 

target time 

of 2.5 hours

Conducted 

at least one 

unannounced 

activation

Pre-identified 

staff notified 

to fill all eight 

Incident 

Command 

System core 

functional 

roles due to a 

drill, exercise, 

or real 

incident*

Pre-identified 

staff 

acknowledged 

notification 

within the 

target time of 

60 minutes

Conducted 

at least one 

unannounced 

notification 

outside of 

normal business 

hours

AAR/IPs 

developed 

following 

an exercise 

or real 

incident*

AAR/IPs 

developed 

within target 

time of 60 

days

Re-evaluated 

response 

capabilities 

following 

approval and 

completion 

of corrective 

actions 

identified in an 

AAR/IP

American 

Samoa 1 time 1 out of 1 times Yes 1 time 0 out of 1 times No 4 4 out of 4 times Yes

Guam 2 times 2 out of 2 

times Yes 2 times 2 out of 2 times Yes 2 2 out of 2 times Yes

Marshall 

Islands 3 times 3 out of 3 times Yes 2 times 2 out of 2 times Yes 2 2 out of 2 times Yes

Micronesia 1 time 1 out of 1 

times Yes 0 times 0 out of 0 times No 3 3 out of 3 times No

N.Mariana 

Islands 2 times 2 out of 2 times Yes 2 times 2 out of 2 times No 2 2 out of 2 times No

Puerto Rico 4 times 3 out of 4 

times Yes 4 times 4 out of 4 times No 9 9 out of 9 times Yes

Palau 0 times 0 out of 0 

times No 2 times 2 out of 2 times Yes 4 3 out of 4 times Yes

U.S.Virgin 

Islands 2 times 2 out of 2 times Yes 2 times 2 out of 2 times Yes 4 4 out of 4 times Yes

 *Minimum of 2

Source: CDC, OPHPR (DSLR)

Preparing Children for Emergencies in Palau 

In the Republic of Palau, residents feel strongly that they must pass 

the skills and culture of their traditional heritage to future generations, 

and preparing for emergencies is no exception. One of the activities 

funded by the PHEP cooperative agreement is an annual summer camp 

conducted by the Ministry of Health called Ak Ready (“Are You Ready”). 

In this camp, children aged 8-12 are taught how to prepare for public 

health emergencies that threaten their health and their island. Children 

learn from elders traditional Palauan resiliency strategies, such as how 

to make baskets from leaves, how to make spears for fishing, how to 

build a canoe, and how to catch rainwater for drinking. Learning these 

skills enhances the children’s confidence in being able to survive during 

and after a disaster while learning cultural skills that can be handed 

down to future generations. 

Photo source: Ministry of Health, PW (Palau)
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 153 U.S. Insular Areas

2

Snapshots of Island Preparedness 

American Samoa 

American Samoa consists principally of five volcanic islands and two coral 

atolls covering some 76.2 square miles. (An atoll is an island of coral that 

encircles a lagoon.) It is located approximately 2,300 miles southwest of Hawaii 

and about 2,700 miles northeast of Australia. The capital of American Samoa is Pago Pago.

• Emergency plans and equipment funded by the PHEP cooperative agreement supported critical 

response operations following the tsunami that struck the shores of American Samoa in fall 

2009

• To compensate for the lack of formal public health training available in American Samoa, the 

Department of Health is working to provide practical training in basic epidemiology and public 

health for the existing and future workforce, the majority of whom are now recruited from 

clinical programs. 

Guam

The U.S. territory of Guam is the largest and southernmost of the Mariana 

Islands in the Micronesian region of the western Pacific. It encompasses 212 

square miles and is located some 3,800 miles southwest of Honolulu and 1,500 

miles south of Tokyo. Hagatna is the capital of Guam.

• PHEP funding supported the development of emergency response plans used to prepare the 

public health community and the public for a predicted strike by super typhoon Melor on 

Guam and the Northern Mariana Islands in fall 2009. Super typhoons have winds of at least 

115 mph (185 km/h). 

• Guam is planning to upgrade their current laboratory to a BSL-2 facility for work involving 

agents of moderate potential hazard to personnel and the environment. The establishment 

of this laboratory will eliminate the traditional week-long wait for confirmatory results from 

California. 

Republic of the Marshall Islands (RMI)

The RMI is part of the larger geographic region known as Micronesia, or “Little 

Islands,” and is made up of 29 coral atolls, each comprising many smaller islets, 

and 5 single islands. The total land area of the approximately 1,225 islands 

and islets is about 70 square miles, which are spread across a sea area of over 

750,000 square miles. RMI’s capital, Majuro, lies some 2,300 miles southwest of Honolulu and 

nearly 2,000 miles southeast of Guam.

• Due to the lack of electricity in some areas and a recent energy crisis in the capital, RMI 

adopted the use of solar power as a main power source for communications equipment, 

lighting, and water treatment, in not only remote island atolls but within the main capital as 

well.

• Emergency plans, training, and equipment funded by the PHEP cooperative agreement has 

supported critical response operations following the many events hitting RMI on an annual 

basis. Of particular note in 2009 were floods, the H1N1 pandemic influenza response, and the 

tsunami warning.
154 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State U.S. Insular Areas

2

Federated States of Micronesia (FSM)

The FSM is a grouping of 607 small islands in the Western Pacific lying just 

above the Equator and about 2,500 miles southwest of Hawaii. While the 

country’s total land area amounts to only 270 square miles, it occupies more 

than one million square miles of the Pacific Ocean, and spans over 1,700 miles from east to west. 

The FSM capital, Palikir, is located on the island of Pohnpei.

• In fall 2009, public health workers traveled for two weeks by boats to deliver the first shipment 

of H1N1 vaccine to the dispersed islands. 

• FSM is focusing on training for first responders and obtaining a better radio communication 

system for emergencies, including the use of solar-powered systems on remote islands where 

electricity is unavailable for regular use. 

Commonwealth of the Northern Mariana Islands (CNMI)

Located just north of Guam, the CNMI is a 300-mile archipelago consisting of 

14 islands, with a total land area of 183.5 square miles. The principal inhabited 

islands are Saipan (the capital), Rota and Tinian; the northern islands are 

largely uninhabited. Saipan is 3,300 miles from Honolulu; 5,625 from San Francisco; 1,272 miles 

from Tokyo; and 3,090 miles from Sydney.

• CNMI is working toward enhancing surveillance by increasing the workforce and implementing 

an electronic disease reporting system. 

• Emergency response plans supported by the PHEP cooperative agreement enabled the CNMI 

public health community to prepare their workforce and the public for a threatened strike by 

super typhoon Melor in fall 2009. Super typhoons have winds of at least 115 mph (185 km/h). 

Republic of Palau

The Palau archipelago consists of more than 500 islands in the Pacific Ocean 

stretching over 150 miles, with a total land area of 188 square miles. Only 

eight of the islands are permanently inhabited. The capital of Palau, Koror, lies 

3,997 miles west/southwest of Honolulu; 813 miles south of Guam; and 530 miles from Manila.

• Palau is working to address gaps in emergency preparedness knowledge and skills identified 

for health care workers, emergency response personnel, staff, volunteers, and targeted 

populations in the general public.

• The public health community in Palau is using geographic information system coordinates to 

identify vulnerable populations.

Snapshots of Island Preparedness
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 155 U.S. Insular Areas

2

Puerto Rico

Puerto Rico consists of one main island and several smaller islands with a total 

land area of 3,435 square miles between the Atlantic Ocean and the Caribbean 

Sea. It is located approximately 1000 miles southeast of Florida and 50 miles 

west of the U.S. Virgin Islands. The capital of Puerto Rico is San Juan. 

• Puerto Rico is planning to establish a biological (BSL-2 and 3) and chemical (Level 2) emergency 

laboratory to serve its own population and those of its Caribbean neighbors.

• Puerto Rico uses global positioning and geographic information systems to ensure better 

preparedness for identified special populations such as the elderly, children, and tourists. 

In addition, Puerto Rico has developed an electronic reporting system for emergency 

management that is compliant with CDC’s Public Health Information Network.

U.S. Virgin Islands (USVI)

The USVI are located between the Atlantic Ocean and the Caribbean Sea, 

some 1100 miles southeast of Florida and 50 miles east of Puerto Rico. USVI 

consists of 4 larger islands and some 50 smaller islands for a total of about 133 

square miles. The USVI capital, Charlotte Amalie, is located on the island of St. Thomas. 

• The USVI are conducting trainings in the National Incident Management System and the 

National Response Plan. 

• In fall 2009, H1N1 vaccination campaigns were conducted in all schools on the islands of St. 

Thomas, St. Croix, and St. John.

Snapshots of Island Preparedness
156 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendices

Appendices

• Appendix 1: Explanation of Fact Sheet Data Points 

• Appendix 2: Overview of CDC Organizations Involved in 

Preparedness Activities

• Appendix 3: Terrorism Preparedness and Emergency Response 

Funding 

• Appendix 4: Public Health Emergency Preparedness Cooperative 

Agreement Funding 

• Appendix 5: Public Health Emergency Response Grant Funding

• Appendix 6: Cities Readiness Initiative Technical Assistance Review 

Scores for 2007-2008

• Appendix 7: Data Sources 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 157 Appendix 1

Appendix 1: Explanation of Fact Sheet Data Points

The data points included in the national summary tables on pages 26 and 34 and the individual 

fact sheets beginning on page 42 are bulleted below, followed by an explanation of its significance. 

Laboratories: General

Maintaining core laboratory functions during an emergency 

• Status of continuity of operations plan (COOP)

A COOP is critical in an emergency situation to ensure that core functions of state public 

health laboratories are not disrupted. 

Ensuring availability of Laboratory Response Network (LRN) laboratory results for decision 

making

• State and locality had a standardized electronic data system capable of messaging laboratory 

results between LRN laboratories and also to CDC

 States need the capability to manage and share laboratory data related to their LRN 

testing, and it is critical that all LRN laboratories use the same data standards and 

vocabulary. An electronic messaging system allows data to flow between laboratories and 

to CDC through a reliable mechanism using consistent data standards, ensuring that data 

are available quickly for decision making.

Laboratories: Biological Capabilities

Participation in LRN for biological agents 

CDC manages the LRN, a group of local, state, federal, and international laboratories. CDC funds 

one biological LRN public health laboratory in every state and in the District of Columbia as part 

of the Public Health Emergency Preparedness (PHEP) cooperative agreement (with the exception 

of California, Illinois, and New York, which have two laboratories). Additional laboratories 

that participate in the LRN include state and locally funded public health laboratories as well 

as federal, military, international, university, agricultural, veterinary, food, and environmental 

testing laboratories. LRN provides a critical laboratory infrastructure to detect, characterize, and 

communicate about confirmed threat agents, decreasing the time needed to begin the response 

to an intentional act or naturally occurring outbreak. 

• LRN reference and/or national laboratories that could test for biological agents

LRN biological laboratories are designated as national, reference, or sentinel laboratories. 

National laboratories, including those at CDC, are responsible for specialized strain 

characterizations, bioforensics, select agent activity, and handling highly infectious 

agents. Reference laboratories perform tests to detect and confirm the presence of a 

threat agent. Sentinel laboratories are primarily hospital-based and can test samples 

to determine whether they should be shipped to reference or national laboratories for 

further testing.

Assessing if laboratory emergency contacts could be reached 24/7

• LRN laboratories successfully contacted during a non-business hours telephone drill

 The LRN emergency contacts telephone drill tests CDC’s ability to reach biological 

laboratory emergency contacts 24 hours a day, seven days a week.
158 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 1

Evaluating LRN laboratory capabilities 

• Proficiency tests passed by LRN reference and/or national laboratories 

 CDC proficiency tests are composed of a number of unknown samples that are tested in 

order to evaluate the abilities of LRN reference and/or national biological laboratories 

to receive, test, and report on one or more suspected biological agents. If a laboratory is 

unable to successfully test for an agent within a specified period of time and report results, 

then the laboratory will not pass the proficiency test. 

Rapid identification of disease-causing bacteria by PulseNet laboratories

States must be able to detect and determine the extent and scope of potential outbreaks and to 

minimize their impacts. The intent of this performance measure is to determine if a laboratory 

can rapidly receive, test, and report disease-causing bacteria within a specified timeframe. 

Laboratories in the PulseNet network use CDC’s pulsed-field gel electrophoresis (PFGE) protocols 

to rapidly identify specific strains Escherichia coli O157:H7 and Listeria monocytogenes

The 4 working-day timeframe of the performance measure allows states to demonstrate their 

ability to analyze samples and submit to the PulseNet database. This database is used by the 

PulseNet network (consisting of local, state and federal public health and food regulatory agency 

laboratories), which is coordinated by CDC.

• Rapidly identified E. coli O157:H7 using advanced DNA tests (PFGE)

ͳ Samples for which state performed tests

ͳ Test results submitted to PulseNet database within 4 working days (target: 90%)

• Rapidly identified L. monocytogenes using advanced DNA tests (PFGE)

ͳ Samples for which state performed tests

ͳ Test results submitted to PulseNet database within 4 working days (target: 90%)

Assessing laboratory competency and reporting through exercises

• State public health laboratory conducted exercises to assess competency of sentinel 

laboratories to rule out bioterrorism agents

 These exercises assess the competency of sentinel clinical laboratories to rule out 

bioterrorism agents. Sentinel laboratories represent the thousands of hospital-based, 

clinical institutions, and commercial diagnostic laboratories that have direct contact 

with patients. Some but not all sentinel laboratories are part of CDC’s LRN. Sentinel 

laboratories provide routine diagnostic services, rule-out testing, and referral steps in 

the identification process and can play a key role in the early detection of biological 

agents by referring a suspicious sample to the right reference lab.

• CDC-funded LRN laboratory ability to contact the CDC Emergency Operations Center within 2 

hours during LRN notification drill. (Note: There is one CDC-funded LRN laboratory in the District 

of Columbia and in each state, with the exception of California, Illinois, and New York, which 

have two.)

 LRN notification drills ensure that biological laboratories can contact the CDC Emergency 

Operations Center (EOC) to report results to EOC watch staff and duty officers within 

2 hours of obtaining a result. Only laboratories funded through CDC’s Public Health 

Emergency Preparedness cooperative agreement participate in this drill. These drills are 

associated with participation in a specific proficiency test; CDC-funded laboratories that 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 159 Appendix 1

cannot participate in the test are excluded from this drill. Reasons for non-participation 

in the proficiency test include the following: laboratory does not test for agent, facility 

renovations or permit issues prevent laboratory from accepting samples, and laboratory 

has equipment issues.

Laboratories: Chemical Capabilities

Participation in Laboratory Response Network for chemical agents (LRN-C)

CDC manages the LRN, a group of local, state, federal, and international laboratories. The LRN 

provides a critical public health laboratory infrastructure to detect, characterize, and communicate 

about confirmed threat agents, decreasing the time needed to begin the response to an 

intentional act or accidental exposure.

• LRN-C laboratories with capabilities for responding if the public is exposed to chemical agents 

(Note: There are three levels, with Level 1 having the most advanced capabilities.)

ͳ Level 1 laboratories are national surge capacity laboratories that maintain the 

capabilities of Level 2 and Level 3 laboratories, can test for an expanded number of 

agents using highly automated analysis methods, maintain an adequate supply of 

materials to analyze 1,000 patient samples for each method, and can operate 24/7 for 

an extended period of time.

ͳ Level 2 laboratories maintain the capabilities of Level 3 laboratories, can test for a 

limited panel of toxic chemical agents, and stock materials and supplies for the analysis 

of at least 500 patient samples for each qualified analysis method. 

ͳ Level 3 laboratories work with hospitals, poison control centers, and first responders 

within their jurisdictions to maintain competency in clinical specimen collection, storage, 

and shipment. 

Evaluating LRN-C laboratory capabilities through proficiency testing

• Core methods successfully demonstrated by Level 1 and/or Level 2 laboratories to rapidly detect 

chemical agents

 LRN methods can help determine how widespread an incident was, identify who does/

does not need long-term treatment, assist with non-emergency medical guidance, and 

help law enforcement officials determine the origin of the agent. Level 1 and Level 2 

laboratories undergo proficiency testing to determine if they can rapidly detect and 

measure chemical agents that can cause severe health effects. CDC has identified six core 

methods for detecting and measuring these agents, and conducts testing to determine 

a laboratory’s proficiency in these methods. This report presents final proficiency 

testing results as the number of these core methods successfully demonstrated by the 

laboratories in each state or locality. The maximum number is 6 core methods. However, 

it should be noted that the states and localities with Level 1 and Level 2 laboratories that 

are not proficient in all six core methods may have completed extensive work in the two 

steps that precede proficiency testing: training and validation in the core methods. 

• Additional methods successfully demonstrated by Level 1 and/or Level 2 laboratories to rapidly 

detect chemical agents 

 In addition to proficiency in core methods, certain LRN laboratories demonstrate 

proficiency in up to six additional methods. Level 1 laboratories are required to gain 
160 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 1

proficiency in these additional methods, while Level 2 laboratories may choose to do 

so or not. There are currently six additional methods in which Level 1 laboratories must 

demonstrate proficiency, and five additional methods in which Level 2 laboratories may 

choose to become proficient. A successful demonstration in the testing indicates ongoing 

proficiency. The figures presented in the fact sheets represent the number of additional 

methods for which laboratories in the state or locality demonstrated proficiency relative 

to the number of tests they undertook. Because the list of additional methods continues 

to increase, state and local laboratories are not expected to be proficient in all additional 

methods. Laboratories may have trained in additional methods, and/or undergone 

validation for additional methods, which are steps that precede proficiency testing. 

Assessing LRN-C laboratory capabilities through exercises

• LRN-C laboratory ability to collect, package, and ship samples properly during LRN exercise

 This annual exercise evaluates the ability of a laboratory to collect relevant samples 

for clinical chemical analysis and ship those samples in compliance with International 

Air Transport Association regulations. Multiple sites in Florida and Illinois have the 

opportunity to participate in this exercise. For these two states, all results are reported.

• Chemical agents detected by Level 1 and/or Level 2 laboratories in unknown samples during 

the LRN Emergency Response Pop Proficiency Test (PopPT) Exercise 

 This annual exercise tests a laboratory’s emergency response capabilities, focusing on 

the detection and measurement of specific agents. To participate in a PopPT exercise, the 

laboratory must have attained a “Qualified” status for the method. To attain “Qualified” 

status, a laboratory must have completed training, the validation exercise, and passed 

at least one scheduled PT exercise. Laboratories participating in the PopPT exercise are 

called the day before the exercise, are sent a minimum of 10 unknown samples, and 

must test these samples within a certain number of hours (depending on the methods 

needed). The August 2008 exercise tested a lab’s ability to detect, identify, and quantify 

two unknown agents. The exercise also tested the laboratory’s emergency contact 

process and its ability to report results to the LRN. 

• Hours to process and report on 500 samples by Level 1 laboratory during the LRN Surge 

Capacity Exercise (range was 71 to 126 hours)

 This exercise demonstrates the ability of each Level 1 laboratory to test and report on 

500 samples (a total of 5000 samples) on a 24/7 basis as would be required by a large 

scale chemical incident. The response time was determined from the delivery of the 500 

samples until the time the last sample was reported to CDC. 

Response Readiness: Communication

Communicating emerging health information

• State and locality public health department had a 24/7 reporting capacity system that could 

receive urgent disease reports any time of the day 

 State and locality public health departments with a 24/7 reporting capacity system are 

able to receive urgent disease reports any time of the day instead of just during regular 

business hours.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 161 Appendix 1

• Responded to Health Alert Network (HAN) test message within 30 minutes

 As a component of CDC’s Public Health Information Network, HAN provides information to 

state and local public health practitioners, clinicians, and public health laboratories about 

urgent health events. Responding to a HAN test message within 30 minutes demonstrates 

that state and locality public health staff are able to receive urgent messages quickly.

• State public health laboratory used HAN or other rapid method (blast email or fax) to 

communicate with sentinel laboratories and other partners for outbreaks, routine updates, 

training events, and other applications

 This number demonstrates the frequency with which state public health laboratories used 

rapid methods to communicate with sentinel laboratories and other partners. See page 

157 for a definition of sentinel, reference, and national laboratories. 

• Epidemic Information Exchange (Epi-X) users responded to system-wide notification test within 

3 hours

 Epi-X is a secure, CDC web-based communication system that enable CDC officials, 

state and local health departments, poison control centers, and other public health 

professionals to access and share preliminary health surveillance information quickly. 

Epi-X provides rapid reporting, immediate notification, editorial support, and coordination 

of health investigations for public health professionals about disease outbreaks and 

other public health events that potentially involve multiple jurisdictions. To protect the 

sensitive nature of the preliminary information it provides, access is limited to designated 

officials who are engaged in identifying, investigating, and responding to health threats. 

To determine the effectiveness of Epi-X as a rapid communication and notification system, 

users were tested on their ability to log into the system and view a test report within 3 

hours. The test, which was conducted in April 2008, was designed to identify and address 

problems that could occur before a real event. 

Improving public health information exchange

• Participated in a Public Health Information Network forum (community of practice) to leverage 

best practices for information exchange

 The Public Health Information Network is a national CDC-sponsored initiative to improve 

public health use and exchange of information by promoting the use of standard and 

technical requirements. Communities of practice provide a forum for members to 

work together to identify and leverage best practices and standards for public health 

information technology and informatics. The goal is to enhance preparedness through 

improved public health information exchange.

Response Readiness: Planning

Assessing plans to receive, distribute, and dispense medical assets from the Strategic National 

Stockpile and other sources.

The CDC Strategic National Stockpile has large quantities of medicine, vaccines, and medical 

supplies placed in strategic locations around the nation to supplement state and local public health 

agencies in the event of a large-scale public health emergency.
162 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 1

• CDC technical assistance review (TAR) state score

 All 62 PHEP-funded states, localities and U.S. insular areas have plans for receiving, 

distributing, and dispensing medical assets from the Stockpile. State technical assistance 

reviews to access these plans are conducted by CDC on an annual basis to ensure 

continued readiness. Using a scale from zero to 100, a CDC TAR score of 69 or higher 

indicates that a state performed in an acceptable range in its plan to receive, distribute, 

and dispense medical assets. (The acceptable threshold score has increased to 79 or 

higher for 2009-2010.)

• Cities Readiness Initiative (CRI) Location and 2007-08 TAR score

CRI focuses on enhancing preparedness in the nation’s major population centers, where 

more than half of the U.S. population resides. A CRI location is a metropolitan statistical 

area (MSA) composed of multiple counties based on Census Bureau data. Through CRI, 

state and large metropolitan public health departments have developed plans to respond 

to a large-scale bioterrorist event within 48 hours. 

 The first CRI cohort started in 2004 with 21 cities; the second cohort added 15 MSAs in 

2005; the third cohort added 36 MSAs in 2006, for a total of 72 and at least one CRI MSA 

in every state. MSAs can be composed of one or more jurisdictions (e.g., counties, cities, 

and municipalities) and can extend across state borders, resulting in the representation 

of several states within one MSA. To ensure continued readiness, TARs are conducted 

annually in each local jurisdiction. CDC is responsible for conducting 25% of the TARs 

while the state is responsible for the other 75%. The TAR scores (ranging from 0 to 100) 

for each planning jurisdiction are combined to compute an average score for the CRI MSA. 

Enhancing response capability for chemical events

• CHEMPACK nerve-agent antidote containers

 CHEMPACK is a nationwide program to place containers of nerve-agent antidotes at state 

and local levels, which increases the capability to respond quickly to a chemical event.

Meeting preparedness standards for local health departments

• Local health departments meeting voluntary Project Public Health Ready preparedness standards

 The vision for this voluntary project is to fully integrate local health departments and the 

response community. This competency-based project assesses preparedness and assists 

local health departments or groups of departments working collaboratively to respond 

to emergencies. Participating local health departments work through a set of criteria for 

preparedness planning and workforce competency goals, and conduct exercises to test 

and identify gaps in their preparedness plans.

Response Readiness: Exercises and Incidents

Notifying emergency operations center (EOC) staff

Rapid notification of EOC staff is critical for an effective response. To ensure timely and effective 

coordination within the public health agency and with key response partners in a complex 

incident, states and localities must demonstrate the capability to rapidly notify staff to report for 

EOC duty. They must also track responses to ensure that eight core Incident Command System 

(ICS) functional roles can be staffed with one person per position. 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 163 Appendix 1

The ICS specifies that states and localities have a pre-identified list of personnel required to cover 

eight core ICS functional roles: Incident Commander, Public Information Officer, Safety Officer, 

Liaison Officer, Operations Section Chief, Planning Section Chief, Logistics Section Chief, and 

Finance/Administration Section Chief. This capability is critical to maintain even though not every 

incident requires full staffing of the ICS. 

All of the ICS functional roles may or may not be used based on incident needs. The widespread 

use of ICS by all levels of government – federal, state, tribal, and local – as well as by many 

nongovernmental organizations and the private sector, enables personnel to work together using 

common terminology, procedures, and organizational structures. 

• Pre-identified staff notified to fill all eight Incident Command System (ICS) core functional roles 

due to a drill, exercise, or real incident

 The intent of this performance measure is to demonstrate the capability to rapidly notify 

staff with incident management functional responsibilities that the EOC is being activated 

(see Activations below). States and localities are required to report details on a minimum 

of two notification drills, exercises, or real incidents. States and localities can report an 

unlimited number of drills, exercises, or real incidents, but can only provide details for 

a maximum of 12 for the entire year (a maximum of six for each of the two reporting 

periods within the entire year). This CDC report provides information on the detailed 

notification drills, exercises, or incidents. States and localities may have conducted 

additional notifications. 

• Pre-identified staff acknowledged notification within the target time of 60 minutes

 This performance measure, related to the measure above, considers the time for staff 

with public health agency ICS functional responsibilities to acknowledge the notification. 

• Conducted at least one unannounced notification outside of normal business hours

 States and localities must be able to demonstrate that all eight core ICS functional roles 

can be staffed rapidly outside of normal business hours without advance warning.

Activating the emergency operations center (EOC)

Activation is defined as rapidly staffing all eight core Incident Command System (ICS) functional 

roles in the public health emergency operations center with one person per position. This 

capability is critical to maintain even though not every incident requires full staffing of the ICS.

• Public health EOC activated as part of a drill, exercise, or real incident

 The intent of this performance measure is to demonstrate the capability for all eight 

staff having core ICS functional responsibilities to report for duty at the public health 

EOC. States and localities are required to report a minimum of two activations. States 

and localities can report an unlimited number of activations, but can only provide details 

for a maximum of 12 for the entire year (a maximum of six for each of the two reporting 

periods within the entire year). This CDC report provides information on the detailed 

activations. States and localities may have conducted additional activations.

• Pre-identified staff reported to the public health EOC within the target time of 2.5 hours

 This performance measure, related to the measure above, considers the time for staff 

with public health agency Incident Command System functional responsibilities to report 

for duty at the public health agency’s EOC. 
164 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 1

• Conducted at least one unannounced activation

 States and localities must be able to demonstrate that all eight core ICS functional roles 

can be staffed rapidly outside of normal business hours without advance warning.

Response Readiness: Evaluation

Assessing response capabilities through after action report/improvement plans (AAR/IPs)

AAR/IPs help assess what worked well during an exercise or real event and what can be improved. 

States and localities evaluate their actions during both exercises and real incidents, identify 

needed improvements, and prepare a plans for making improvements by developing after action 

reports and improvement plans (AAR/IPs). These should include how response operations did 

and did not meet objectives, recommendations for correcting gaps or weaknesses, and a plan for 

improving response operations.

• AAR/IPs developed following an exercise or real incident

 The intent of this performance measure is to demonstrate the capability to analyze 

response actions, describe needed improvements, and prepare a plan for making 

improvements. States and localities are required to report details on a minimum of two 

AAR/IPs. States and localities can report an unlimited number of AAR/IPs, but can only 

provide details for a maximum of 12 for the entire year (a maximum of six for each of the 

two reporting periods within the entire year). This CDC report provides information on 

the detailed AAR/IPs. States and localities may have developed additional AAR/IPs. 

• AAR/IPs developed within target time of 60 days

 Development of an AAR/IP within 60 days is calculated using the date following the end 

of the exercise or public health emergency response operations as determined by the 

incident commander, and the date the draft AAR/IP was submitted for clearance within 

the public health agency. 

• Re-evaluated response capabilities following approval and completion of corrective actions 

identified in AAR/IPs

 The systematic reevaluation of response capabilities is critical for providing evidence that 

planned corrective actions have been effective in improving response. 

 Research, Training, Education, and Promising Demonstration Projects

In addition to the state activities listed above, CDC supported projects and additional activities 

to enhance state preparedness efforts. Snapshots of these CDC efforts are provided below. 

• Centers for Public Health Preparedness (CPHP)

 This program is an important resource for the development, delivery, and evaluation 

of preparedness education. Colleges and universities within the CPHP program provide 

preparedness education to public health workers, healthcare providers, and students. 

CPHPs collaborate with state, local and tribal health agencies to develop, deliver, and 

evaluate preparedness education based on community need. (CPHPS will be known as 

Preparedness and Emergency Response Learning Centers in FY 2011.) 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 165 Appendix 1

• Preparedness and Emergency Response Research Centers (PERRC)

 PERRCs conduct research to evaluate the structure, capabilities, and performance of 

preparedness and emergency response activities in federal, state, and local public health 

systems. Scientists in the PERRCs at schools of public health must connect with multiple 

partners within the public health infrastructure to incorporate diverse perspectives into 

their research.

• Advanced Practice Centers (APC)

 This network of local health departments develops resources and training that enhance 

the capabilities of all local health departments and the public health system to prepare 

for, respond to, and recover from public health emergencies.

• Centers of Excellence in Public Health Informatics

 These Centers contribute to the efforts of CDC’s Public Health Informatics program 

by advancing the ability of healthcare professionals to communicate health 

recommendations to consumers, and by making the use of electronic information 

systems easier. They seek to improve the public’s health through discovery, innovation, 

and research related to health information and information technology.

• Pandemic Influenza Promising Practices Demonstration Projects 

 Selected state and local public health departments received PHEP cooperative agreement 

and pandemic influenza supplemental funding through a competitive application process 

for projects serving as innovative approaches for pandemic influenza preparedness. These 

projects will provide promising practices or effective approaches that can be replicated 

nationally to improve national, regional, and local public health detection and response to 

an influenza pandemic.

 Additional CDC Resources Supporting Preparedness in States and Localities

• Epidemic Intelligence Service (EIS) 

The EIS program expands the epidemiology workforce through a two-year 

epidemiology training program modeled on a traditional medical fellowship. EIS officers 

(epidemiologists) serve as a critical component to CDC’s support of states during 

responses to routine public health incidents and large-scale national emergencies. 

Officers are assigned to CDC or to state and local health departments.

• Deployments

 CDC personnel are deployed routinely for emergency response operations and EPI-AID 

investigations. For EPI-AID investigations, CDC’s Epidemic Intelligence Service officers, 

along with other CDC staff, provide technical support to state health agencies requesting 

assistance for epidemiologic field investigations of disease outbreaks or health 

emergencies. Data points include the type of incident and number of CDC staff deployed. 

• Career Epidemiology Field Officers (CEFOs)

 CDC places experienced, full-time epidemiologists in state and local public health 

departments to enhance and build epidemiologic capacity for public health preparedness 

and response. (States use PHEP funds to support CEFO positions.) CEFOs also serve as 

liaisons and consultants between CDC and public health departments as well as mentors 

for state and local public health department staff and EIS officers assigned to state or 

local health departments. 
166 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 1

• Quarantine Stations

 CDC’s domestic quarantine stations, strategically located at U.S. ports of entry where the 

majority of international travelers arrive in the United States, are essential for detecting 

and responding to diseases of public health significance. The public health officials who 

operate these stations implement measures to prevent the spread of infectious diseases.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 167 Appendix 2

Appendix 2: Overview of CDC Organizations Involved 

in Preparedness Activities

The Centers for Disease Control and Prevention (CDC) builds and strengthens systems at local, state, and federal levels to respond to all hazards. For more information, see CDC’s Emergency 

Preparedness and Response website (emergency.cdc.gov).

CDC’s emergency preparedness and response is a collective effort among the different offices and national 

centers. The Office of Public Health Preparedness and Response (OPHPR) provides strategic direction, 

support, and coordination for CDC’s preparedness and emergency response activities that receive 

Terrorism Preparedness and Emergency Response funding. In addition to the programs that OPHPR 

manages directly, other CDC organizations and programs make significant contributions to emergency 

preparedness and response and are also listed below. (Please note: the listing below reflects the new 

structure developed as part of CDC’s 2009 organizational improvement process. For more information 

see www.cdc.gov/about/organization/cio.htm.)

Preparedness

The Office of Public Health Preparedness and Response (OPHPR) (formerly the Coordinating Office for 

Terrorism Preparedness and Emergency Response) coordinates terrorism preparedness and emergency 

response activities across CDC and strategically distributes funds that support a range of activities at CDC 

and state and local public health departments. OPHPR manages the following divisions and offices:

• The Division of State and Local Readiness (DSLR) manages the Public Health Emergency Preparedness 

(PHEP) cooperative agreement, which funds state and local efforts to strengthen response to a public 

health emergency and provides technical assistance to promote these efforts. In response to the 

2009 H1N1 influenza pandemic, DSLR also administered funds through the Public Health Emergency 

Response (PHER) grant to upgrade pandemic influenza preparedness and response capacity.

• The Division of Strategic National Stockpile (DSNS) operates and maintains the Strategic National 

Stockpile, a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, 

and medical supplies. During a public health emergency, state and local public health systems 

may become overwhelmed. The Stockpile is designed to supplement state and local public health 

departments in the event of such an emergency. DSNS also provides technical assistance to local 

officials to help ensure that local, state, and federal agencies can work together to receive, stage, store, 

distribute, and dispense medical assets from the Stockpile as well as other sources.

• The Division of Emergency Operations (DEO) coordinates CDC’s preparedness, assessment, response, 

recovery, and evaluation prior to and during public health emergencies. DEO has overall responsibility 

for the CDC Emergency Operations Center (EOC), which maintains situational awareness of potential 

health threats 24 hours a day and is the centralized location for event management when activated. 

The EOC is equipped with state-of-the-art communications technologies to support information 

pipelines with state, federal, and international partners. 

• The Division of Select Agents and Toxins (DSAT) through the Select Agent Program regulates the 

possession, use, and transfer of biological agents and toxins (select agents) that have the potential to 

pose a severe threat to public health and safety. This program is designed to ensure compliance with 

the select agent regulations by providing guidance and evaluating and inspecting registered entities.

• The Office of the Director (OD) manages strategy, budget, policy, workforce and career planning, 
168 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 2

communication, research, and science for terrorism preparedness and emergency response 

activities. In addition, OD manages the Career Epidemiology Field Officer program, which recruits 

and supports skilled epidemiologists in state and local public health departments. Through this 

program, state public health departments can choose to spend PHEP cooperative agreement 

funds to support a field officer in their agencies. OD also manages the Centers for Public Health 

Preparedness program (will be known as Preparedness and Emergency Response Learning Centers 

in FY 2011), a national network of colleges and universities that collaborates with state and local 

public health departments and other community partners to provide preparedness education and 

training resources to the public health workforce, healthcare providers, students, and others based 

on community need.

Global Health

The Center for Global Health (CGH) (formerly the Coordinating Office for Global Health) provides 

leadership and works with global partners to increase life expectancy and years of quality of life, and 

also to increase global preparedness to prevent and control natural and manmade threats to health. 

CDC’s global health presence includes more than 200 CDC staff assigned to more than 50 countries and 

international organizations. 

CGH coordinates international response with the CDC Emergency Operations Center during 

international emergency response events and serves as the principal CDC point of contact for CDC 

programs, federal agencies, foreign governments, and other organizations concerned with international 

terrorism preparedness and response. CGH also works to build global public health capacity to identify, 

investigate, and contain outbreaks and other major public health emergencies. In addition, CGH 

provides epidemic aid and epidemiologic consultation and reference diagnostic services to state and 

local health departments, other federal agencies, and national and international health organizations. 

Infectious Diseases

The Office of Infectious Diseases (OID) (formerly the Coordinating Center for Infectious Diseases) 

strives to protect the public’s health by preventing and controlling infectious diseases. OID’s ongoing 

public health preparedness activities include developing vaccine, improving diagnostic methods for 

select bioterrorism agents, and improving the Laboratory Response Network. Their mission is to lead, 

promote, and facilitate science, programs, and policies to reduce the burden of infectious diseases in 

the United States and globally. 

• The Influenza Coordination Unit (ICU) is responsible for all aspects of CDC’s pandemic influenza 

preparedness, from strategy through implementation. The ICU coordinates and synchronizes all 

pandemic influenza-related activities within CDC to ensure preparedness for a possible pandemic. 

These activities include setting priorities and promoting science, policies for the programs related 

to CDC’s pandemic influenza activities, exercising readiness plans, and facilitating community 

preparedness.

• The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) (formerly the National 

Center for Zoonotic, Vector-Borne, and Enteric Diseases and the National Center for Preparedness, 

Detection, and Control of Infectious Diseases) aims to detect, prevent, and control infectious 

diseases from spreading, whether they are naturally occurring, unintentional, or the result of 

terrorism. NCEZID manages the biological testing component of the Laboratory Response Network, 

an integrated network of national, reference or sentinel laboratories whose goal is to detect, 

characterize, and communicate about confirmed biological agents, decreasing the time needed 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 169 Appendix 2

to begin the response to an intentional act or accidental exposure. In addition, NCEZID tests the 

continuing effectiveness of existing drugs against bioterrorism agents and prepares U.S. ports of entry 

to reduce the risk of natural or intentional introduction of infectious diseases into the country. 

• The National Center for Immunization and Respiratory Diseases (NCIRD) works to prevent disease, 

disability, and death through immunization and by control of respiratory and related diseases. During 

the 2009 H1N1 influenza pandemic, NCIRD provided leadership; laboratory, epidemiology, and clinical 

subject matter expertise; and vaccine delivery expertise. To prepare against natural and intentional 

outbreaks, the center also conducts surveillance and laboratory activities for vaccine-preventable 

diseases and viral and bacterial respiratory diseases. As part of the Anthrax Vaccine Research 

Program, NCIRD has recently completed a large-scale human clinical trial of the anthrax vaccine and 

immunological studies in animals. NCIRD is also evaluating the use of anthrax immunoglobulin for 

severe systemic anthrax.

Noncommunicable Diseases, Injury and Environmental Health

The Office of Noncommunicable Diseases, Injury and Environmental Health’s (ONDIEH) (new office 

established as part of CDC’s 2009 organizational improvement) mission is to increase the potential 

for full, satisfying, and productive living across the lifespan for all people in all communities. ONCDIEH 

preparedness activities include providing technical expertise in epidemiology, surveillance, and 

communications during emergencies for populations with physical and developmental disabilities and 

chronic diseases as well as at-risk populations. 

• The National Center on Birth Defects and Developmental Disabilities (NCBDDD) is conducting 

ongoing projects to develop and strengthen intramural research and surveillance capacity related to 

emergency preparedness for at-risk populations.

• The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has produced 

a number of publications addressing issues surrounding persons with chronic diseases following 

natural disasters. 

• The National Center for Environmental Health/Agency for Toxic Substances and Disease Registry 

(NCEH/ATSDR) conducts ongoing projects to improve surveillance systems, laboratory capacity, and 

emergency response. NCEH/ATSDR manages the chemical testing component of the Laboratory 

Response Network, an integrated network of state and national laboratories whose goal is to detect, 

characterize, and communicate about confirmed chemical agents, decreasing the time needed to 

begin the response to an intentional act or accidental exposure. In addition, NCEH/ATSDR is improving 

various surveillance systems for chemical exposures, hazardous substance spills, and morbidity 

following disasters. NCEH/ATSDR also works with state and local public health departments to 

improve response to chemical, nuclear, and radiologic terrorism.

• The National Center for Injury Prevention and Control (NCIPC) links to the injury care community 

to decrease morbidity and mortality from injuries caused by explosions. NCIPC is moving toward this 

goal through curriculum development for healthcare providers, development of clinical guidance 

resources for management of blast injuries, and translation of lessons learned from international and 

U.S. military experience. NCIPC is also working to improve surveillance systems for blast injuries due 

to bombings and behavioral/mental health outcomes associated with disasters and incidents of mass 

violence and is providing educational materials to prevent or reduce the impact of these events on 

mental health and behavioral health outcomes. 
170 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 2

Occupational Safety and Health

The National Institute for Occupational Safety and Health (NIOSH) provides leadership to prevent 

work-related illness, injury, disability, and death through information gathering, scientific research, and 

translation of knowledge into products and services. 

The mission of the NIOSH Emergency Preparedness and Response program is to advance research and 

collaborations to protect the health and safety of emergency response providers and recovery workers by 

preventing diseases, injuries, and fatalities when responding to emergencies.

State, Tribal, Local and Territorial Support 

The Office for State, Tribal, Local and Territorial Support’s (OSTLTS) (new office established as part of CDC’s 

2009 organizational improvement) vision is to improve the health of America by supporting state, local, 

tribal, and territorial public health agencies to expand and develop their capacity in programs and policies 

related to the improvement of the health status of the nation. OSTLTS’ activities will focus on public health 

systems (government relations, partners and strategic alliances, workforce development, and information 

technology and management which includes the Public Health Information Network), public health 

practice (Public Health Law program, technical assistance, and capacity development and improvement), 

and performance and accountability (public health standards and accreditation as well as program review, 

assessment and analysis).

Surveillance, Epidemiology and Laboratory Services

The Office of Surveillance, Epidemiology, and Laboratory Services’s (OSELS) (new office established as 

part of CDC’s 2009 organizational improvement) mission is to provide scientific service, expertise, skills, 

and tools in support of CDC’s national efforts to promote health; prevent disease, injury and disability; and 

prepare for emerging health threats. OSELS will lead the development, adoption, and integration of sound 

national and international public health surveillance and epidemiological practices, based on advances in 

informatics, epidemiology, laboratory science, and public health research.

• The National Center for Health Statistics (NCHS) conducts and supports statistical, methodological, and 

epidemiological activities that will provide the data needed to improve the effectiveness, efficiency, and 

quality of health services in the United States.

 Among the surveys fielded by NCHS is the National Hospital Ambulatory Medical Care Survey. The 

survey is used annually to monitor emergency department crowding and has occasionally included 

supplements that help illustrate if emergency departments have the necessary training to recognize and 

treat patients suffering from diseases such as exposure to anthrax, and have formal plans to respond 

to mass casualty events. These data provide important context for planning and evaluating emergency 

preparedness programs at the national level, and may be used as benchmarks for individual states.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 171 Appendix 3

Appendix 3: Terrorism Preparedness and 

Emergency Response Funding 

Table 1: CDC’s Terrorism Preparedness and Emergency Response Funding; FY 2002-2009 

Terrorism- Budget 

Authority 

Budget Activity/

Description 

FY 2002

Appropriation

FY 2003

Appropriation

FY 2004

Appropriation

FY 2005

Appropriation

FY 2006 

Appropriation

FY 2007

Appropriation

FY 2008

Appropriation

FY 2009

Appropriation

State and Local 

Preparedness 

and Response 

Capability*

$940,174,000 $1,038,858,000 $918,454,000 $919,148,000 $823,099,000 $766,660,000 $746,039,000 $746,596,000 

CDC Preparedness 

and Response 

Capability**

$161,849,000 $196,566,000 $191,117,000 $236,909,000 $283,735,000 $209,545,000 $181,907,000 $197,754,000 

Strategic National 

Stockpile $645,000,000 $298,050,000 $397,640,000 $466,700,000 $524,339,000 $496,348,000 $551,509,000 $570,307,000 

Total Terrorism 

Preparedness 

and Emergency 

Response Funding

$1,747,023,000 $1,533,474,000 $1,507,211,000 $1,622,757,000 $1,631,173,000 $1,472,553,000 $1,479,455,000 $1,514,657,000 

 *Includes Public Health Emergency Preparedness (PHEP) cooperative agreement, Centers for Public Health Preparedness, Advanced Practice 

Centers (FY 2004-09), Health Alert Network (FY 2002-03), Cities Readiness Initiative, U.S. Postal Service Costs (FY 2004), All Other State and Local 

Capacity, and Smallpox Supplement (FY 2003) 

**Includes Upgrading CDC Capacity, Anthrax, BioSense (FY 2004-09), Quarantine (FY 2004-09), and Real Time Lab Reporting (FY 2005-09)

 Source: Annual Labor, Health and Human Services, Education, and Related Agency Appropriation Bills and Reports (FY 2002–2009)

 Note: All funding appropriation levels have been made comparable to reflect realignments, transfers, and/or reprogramming. 
172 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 4

Appendix 4: Public Health Emergency Preparedness 

Cooperative Agreement Funding 

FY 2002 FY 20032 FY 2004 FY 2005 FY 2006 

Alabama $14,900,443 $15,598,792 $12,910,651 $12,809,991 $11,332,549

Alaska $6,395,720 $6,502,762 $5,205,459 $5,210,372 $5,176,673

American Samoa $544,481 $576,463 $444,499 $447,789 $483,221

Arizona $16,422,170 $17,586,381 $16,470,314 $17,067,370 $15,468,991

Arkansas $10,951,709 $11,390,938 $9,339,265 $9,302,434 $8,513,998

California $60,816,245 $64,203,968 $59,319,441 $61,339,288 $54,396,954

Chicago $11,447,312 $11,378,246 $12,563,491 $12,816,598 $11,685,667

Colorado $14,575,766 $15,508,850 $13,654,314 $13,937,566 $12,343,549

Connecticut $12,581,705 $13,145,748 $10,828,647 $10,801,849 $9,872,607

Delaware $6,744,505 $6,889,271 $5,518,506 $5,596,144 $5,511,936

District of Columbia $11,273,558 $11,360,917 $11,985,069 $11,931,316 $6,702,385

Florida $40,581,081 $43,832,162 $37,583,527 $39,221,056 $34,945,845

Georgia $23,225,251 $24,935,506 $21,575,121 $22,321,610 $19,557,241

Guam $777,788 $679,585 $515,976 $550,696 $658,616

Hawaii $7,697,208 $7,910,098 $6,384,925 $6,381,328 $6,130,741

Idaho $7,880,688 $8,131,994 $6,588,258 $6,629,932 $6,389,623

Illinois $26,201,381 $28,315,621 $23,718,971 $24,044,099 $20,613,241

Indiana $18,536,799 $19,530,623 $16,262,765 $16,461,162 $14,502,083

Iowa $11,514,786 $11,953,663 $9,816,873 $9,725,489 $8,810,613

Kansas $10,985,143 $11,408,553 $9,354,215 $9,296,532 $8,724,480

Kentucky $13,998,067 $14,649,896 $12,105,282 $12,048,544 $10,860,671

Los Angeles County $24,591,171 $27,856,971 $27,069,695 $27,933,032 $24,180,809

Louisiana $14,949,145 $15,602,245 $12,913,581 $12,790,121 $11,478,386

Maine $7,838,322 $8,046,341 $6,600,682 $6,606,543 $6,321,437

Marshall Islands $306,025 $561,544 $434,158 $446,412 $485,107

Maryland $16,791,405 $17,774,011 $14,756,853 $15,290,917 $13,970,953

Massachusetts $19,134,801 $20,181,459 $17,640,158 $17,872,452 $15,512,606

Michigan $27,125,655 $28,731,577 $26,896,854 $27,105,748 $23,221,202

Micronesia $446,522 $653,415 $497,837 $496,736 $562,809

Minnesota $15,952,086 $16,821,680 $14,701,780 $15,003,826 $13,134,147

Mississippi $11,332,975 $11,782,347 $9,671,470 $9,608,208 $8,738,914

Missouri $17,456,448 $18,369,845 $15,952,563 $16,321,799 $14,402,196

Table 1: Public Health Emergency Preparedness Cooperative Agreement Funding for States, 

Localities, and U.S. Insular Areas; FY 2002-20091
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 173 Appendix 4

FY 2007

Total Pandemic 

Influenza 

Supplemental 

Funding3

(FY 2006-2008)

FY 2008 FY 2009 TOTAL 

FY 2002-2009

Alabama $10,228,438 $7,799,356 $10,241,093 $9,984,931 $105,806,244

Alaska $5,015,000 $2,415,422 $5,015,000 $5,015,000 $45,951,408

American Samoa $419,594 $380,155 $386,338 $383,368 $4,065,908

Arizona $14,284,449 $9,638,285 $14,227,671 $13,658,394 $134,824,025

Arkansas $7,533,982 $5,556,599 $7,435,489 $7,279,503 $77,303,917

California $52,023,574 $38,435,457 $50,161,370 $49,341,755 $490,038,052

Chicago $13,806,684 $6,085,093 $11,382,673 $10,699,574 $101,865,338

Colorado $11,234,142 $8,733,589 $11,141,885 $10,637,403 $111,767,064

Connecticut $9,112,072 $6,726,042 $8,927,705 $8,704,406 $90,700,781

Delaware $5,000,000 $2,662,104 $5,000,000 $5,000,000 $47,922,466

District of Columbia $9,129,492 $2,264,267 $6,698,743 $6,461,359 $77,807,106

Florida $33,289,391 $27,239,262 $32,940,501 $32,906,612 $322,539,437

Georgia $18,230,415 $14,746,750 $18,689,009 $18,146,190 $181,427,093

Guam $589,529 $532,250 $555,484 $546,695 $5,406,619

Hawaii $5,296,353 $4,642,440 $5,228,184 $5,144,507 $54,815,784

Idaho $5,439,853 $3,464,188 $5,405,739 $5,330,380 $55,260,655

Illinois $19,245,542 $15,979,832 $19,912,211 $19,985,919 $198,016,817

Indiana $13,406,349 $10,967,717 $13,335,867 $12,979,201 $135,982,566

Iowa $7,832,164 $5,861,390 $7,702,063 $7,540,433 $80,757,474

Kansas $7,709,812 $5,296,518 $7,598,339 $7,446,545 $77,820,137

Kentucky $9,905,373 $7,266,687 $9,750,535 $9,510,505 $100,095,560

Los Angeles County $25,365,277 $15,245,029 $22,852,470 $22,522,771 $217,617,225

Louisiana $10,536,471 $8,155,767 $9,998,186 $9,756,363 $106,180,265

Maine $5,381,949 $4,778,863 $5,271,144 $5,183,337 $56,028,618

Marshall Islands $421,421 $381,169 $390,307 $387,201 $3,813,344

Maryland $12,815,412 $9,235,049 $13,038,391 $12,690,042 $126,363,033

Massachusetts $14,418,081 $10,928,690 $14,805,770 $14,323,704 $144,817,721

Michigan $21,555,319 $17,546,352 $20,453,241 $20,123,542 $212,759,490

Micronesia $496,704 $449,734 $461,346 $455,796 $4,520,899

Minnesota $12,587,653 $10,806,282 $12,616,406 $12,055,280 $123,679,140

Mississippi $7,797,260 $5,536,310 $7,629,747 $7,467,891 $79,565,122

Missouri $13,236,793 $9,513,634 $13,029,088 $12,475,814 $130,758,180

Source: CDC (FY 2002-2003 and FY 2009) and HHS Press Office (FY 2004-2008)

1 Funding categories include: base population funding, Cities Readiness Initiative funding, chemical laboratory funding and 

Early Warning Infectious Disease Surveillance (EWIDS) funding. 

2 Includes $100 million Smallpox Supplement

3 Pandemic influenza supplemental funding was awarded in phases over three years. 
174 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 4

FY 2002 FY 20032 FY 2004 FY 2005 FY 2006 

Montana $7,008,529 $7,147,269 $5,775,627 $5,751,801 $5,616,551

Nebraska $8,809,733 $9,079,368 $7,377,335 $7,346,564 $6,897,069

Nevada $9,448,659 $9,975,108 $8,927,588 $9,267,629 $8,660,838

New Hampshire $7,751,193 $7,986,786 $6,465,014 $6,526,889 $6,252,371

New Jersey $23,732,611 $25,185,572 $21,047,364 $21,953,336 $18,894,214

New Mexico $9,049,687 $9,342,376 $8,803,295 $8,810,432 $8,351,763

New York $29,418,122 $31,675,790 $28,493,781 $28,293,465 $24,409,091

New York City $22,828,585 $23,586,023 $25,874,757 $26,069,578 $22,942,162

North Carolina $22,919,940 $24,462,186 $20,433,395 $20,547,098 $17,877,794

North Dakota $6,429,710 $6,509,688 $5,223,458 $5,193,519 $5,147,111

N. Mariana Islands $314,371 $585,043 $450,446 $465,583 $518,846

Ohio $30,275,149 $32,012,830 $27,626,951 $27,902,321 $24,190,050

Oklahoma $12,682,086 $13,228,697 $10,899,049 $10,840,379 $9,732,169

Oregon $12,616,956 $13,237,862 $10,906,827 $11,154,657 $10,251,502

Palau $192,061 $521,761 $406,583 $410,687 $423,673

Pennsylvania $32,340,936 $34,178,922 $30,735,407 $30,976,767 $26,235,793

Puerto Rico $13,478,640 $14,103,331 $11,641,389 $11,573,929 $10,109,253

Rhode Island $7,333,840 $7,513,164 $6,048,030 $6,240,298 $5,981,291

South Carolina $13,931,820 $14,634,027 $12,091,813 $12,108,891 $10,852,835

South Dakota $6,680,506 $6,798,496 $5,441,461 $5,425,710 $5,339,585

Tennessee $17,665,877 $18,635,684 $15,488,192 $15,459,458 $13,759,228

Texas $51,421,771 $55,684,954 $51,803,533 $53,589,709 $46,595,417

Utah $9,971,636 $10,404,357 $8,501,910 $8,560,504 $8,023,438

Vermont $6,355,413 $6,453,782 $5,198,685 $5,186,880 $5,144,876

Virgin Islands (U.S.) $419,235 $639,297 $488,051 $497,389 $563,765

Virginia $20,758,682 $22,068,328 $19,924,893 $20,475,283 $18,466,632

Washington $18,121,902 $19,214,353 $16,978,969 $17,350,613 $15,353,518

West Virginia $9,025,861 $9,271,321 $7,540,254 $7,498,508 $6,994,949

Wisconsin $16,940,986 $17,821,131 $14,811,846 $14,975,480 $13,246,911

Wyoming $6,099,142 $6,171,022 $4,908,897 $4,906,684 $4,917,055

TOTAL $918,000,000 $970,000,000 $849,596,000 $862,777,000 $766,440,000

Appendix 4: (continued)

Table 1: Public Health Emergency Preparedness Cooperative Agreement Funding for States, 

Localities, and U.S. Insular Areas; FY 2002-20091
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 175 Appendix 4

FY 2007

Total Pandemic 

Influenza 

Supplemental 

Funding3

(FY 2006-2008)

FY 2008 FY 2009 TOTAL 

FY 2002-2009

Montana $5,026,488 $2,791,633 $5,022,876 $5,019,036 $49,159,810

Nebraska $5,966,406 $4,905,111 $5,877,064 $5,774,382 $62,033,032

Nevada $7,662,442 $4,802,505 $7,652,253 $7,292,961 $73,689,983

New Hampshire $5,308,479 $4,173,584 $5,317,054 $5,244,492 $55,025,862

New Jersey $17,584,884 $13,555,855 $18,788,803 $18,247,856 $178,990,495

New Mexico $7,249,926 $4,691,526 $7,054,780 $6,853,141 $70,206,926

New York $22,935,076 $16,937,570 $22,518,790 $22,171,004 $226,852,689

New York City $24,369,122 $13,957,427 $22,371,459 $20,674,333 $202,673,446

North Carolina $16,570,173 $13,462,457 $16,696,497 $16,224,492 $169,194,032

North Dakota $5,028,972 $2,561,342 $5,023,132 $5,023,393 $46,140,325

N. Mariana Islands $454,109 $410,271 $423,185 $418,947 $4,040,801

Ohio $22,745,252 $17,515,265 $21,838,104 $21,312,180 $225,418,102

Oklahoma $8,871,195 $6,403,704 $8,740,269 $8,536,905 $89,934,453

Oregon $9,192,614 $8,070,317 $9,100,217 $8,884,916 $93,415,868

Palau $361,900 $327,977 $330,743 $329,686 $3,305,071

Pennsylvania $24,743,362 $19,151,304 $23,758,643 $22,975,362 $245,096,496

Puerto Rico $9,036,997 $6,909,836 $8,867,670 $8,665,828 $94,386,873

Rhode Island $5,048,931 $3,663,898 $5,012,619 $5,000,000 $51,842,071

South Carolina $9,972,754 $7,367,377 $9,968,869 $10,097,336 $101,025,722

South Dakota $5,000,000 $2,571,976 $5,000,000 $5,000,000 $47,257,734

Tennessee $13,009,292 $9,729,989 $12,844,807 $12,495,537 $129,088,064

Texas $44,570,881 $33,776,583 $43,355,376 $42,816,952 $423,615,176

Utah $7,174,066 $5,172,897 $7,162,839 $7,018,990 $71,990,637

Vermont $5,039,717 $2,362,016 $5,041,316 $5,042,969 $45,825,654

Virgin Islands (U.S.) $497,630 $450,585 $462,244 $456,664 $4,474,860

Virginia $17,109,122 $13,296,679 $17,222,047 $16,613,973 $165,935,639

Washington $14,168,202 $10,351,119 $14,012,182 $13,561,976 $139,112,834

West Virginia $6,026,051 $4,015,006 $5,933,288 $5,839,235 $62,144,473

Wisconsin $12,667,934 $9,152,514 $12,188,297 $12,177,579 $123,982,678

Wyoming $5,000,000 $2,203,619 $5,000,000 $5,000,000 $44,206,419

TOTAL $721,736,525 $524,012,224 $704,867,418 $688,914,546 $7,006,343,713

Source: CDC (FY 2002-2003 and FY 2009) and HHS Press Office (FY 2004-2008)

1 Funding categories include: base population funding, Cities Readiness Initiative funding, chemical laboratory funding and Early 

Warning Infectious Disease Surveillance (EWIDS) funding. 

2 Includes $100 million Smallpox Supplement 

3

 Pandemic influenza supplemental funding was awarded in phases over the years. 
176 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 5

Appendix 5: Public Health Emergency Response 

Grant Funding

FY 2009 

Phase I1

FY 2009 

Phase II2

FY 2009 

Phase III3

 FY 2009 

Phase IV4

TOTAL

 FY 2009

Alabama $3,934,220 $3,981,585 $13,144,433 - $21,060,238 

Alaska $573,193 $1,861,553 $3,623,681 $320,000.00 $6,378,427 

American Samoa $49,441 $531,185 $640,047 - $1,220,673 

Arizona $5,274,949 $4,827,276 $16,942,309 - $27,044,534 

Arkansas $2,404,548 $3,016,715 $8,811,345 - $14,232,608 

California $22,677,408 $15,804,211 $66,238,117 $18,027,241.00 $122,746,977 

Chicago $2,423,752 $2,528,828 $7,865,743 - $12,818,323 

Colorado $4,066,256 $4,064,869 $13,518,450 - $21,649,575 

Connecticut $2,998,173 $3,391,156 $10,492,903 - $16,882,232 

Delaware $730,103 $1,960,526 $4,068,155 - $6,758,784 

District of Columbia $497,467 $1,313,787 $2,409,172 - $4,220,426 

Florida $15,474,914 $11,261,100 $45,835,672 - $72,571,686 

Georgia $8,010,341 $6,552,677 $24,690,834 - $39,253,852 

Guam $146,297 $592,280 $914,416 - $1,652,993 

Hawaii $1,099,673 $2,193,640 $5,115,037 - $8,408,350 

Idaho $1,254,481 $2,291,288 $5,553,559 $352,561.00 $9,451,889 

Illinois $8,553,300 $6,895,159 $26,228,868 - $41,677,327 

Indiana $5,400,873 $4,906,704 $17,299,011 - $27,606,588 

Iowa $2,551,012 $3,109,100 $9,226,230 $550,000.00 $15,436,342 

Kansas $2,364,516 $2,991,464 $8,697,946 - $14,053,926 

Kentucky $3,598,068 $3,769,550 $12,192,218 - $19,559,836 

Los Angeles County $8,510,041 $6,367,873 $25,106,330 - $39,984,244 

Louisiana $3,667,952 $3,813,631 $12,390,180 - $19,871,763 

Maine $1,130,535 $2,213,106 $5,202,457 - $8,546,098 

Marshall Islands $51,713 $532,619 $646,486 - $1,230,818 

Maryland $4,803,949 $4,530,183 $15,608,109 $2,774,069.00 $27,716,310 

Massachusetts $5,506,668 $4,973,437 $17,598,697 - $28,078,802 

Michigan $8,636,273 $6,947,495 $26,463,905 $2,796,574.00 $44,844,247 

Micronesia $92,392 $558,278 $761,717 - $1,412,387 

Minnesota $4,420,173 $4,288,110 $14,520,992 $4,261,776.00 $27,491,051 

Mississippi $2,489,808 $3,070,495 $9,052,862 - $14,613,165 

Missouri $4,998,123 $4,652,662 $16,158,145 - $25,808,930 

Montana $808,081 $2,009,713 $4,289,046 $746,655.00 $7,853,495 

Table 1: Public Health Emergency Response Grant Funding; 2009
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 177 Appendix 5

FY 2009 

Phase I1

FY 2009 

Phase II2

FY 2009 

Phase III3

 FY 2009 

Phase IV4

TOTAL

 FY 2009

Nebraska $1,512,711 $2,454,172 $6,285,045 - $10,251,928 

Nevada $2,134,789 $2,846,559 $8,047,201 - $13,028,549 

New Hampshire $1,124,821 $2,209,503 $5,186,272 - $8,520,596 

New Jersey $7,463,387 $6,207,674 $23,141,477 $3,912,690.00 $40,725,228 

New Mexico $1,672,053 $2,554,680 $6,736,412 - $10,963,145 

New York $9,488,395 $7,484,987 $28,877,702 $3,621,731.00 $49,472,815 

New York City $7,026,995 $5,432,412 $20,905,313 $6,715,863.00 $40,080,583 

North Carolina $7,576,259 $6,278,870 $23,461,208 - $37,316,337 

North Dakota $543,949 $1,843,107 $3,540,842 - $5,927,898 

N. Mariana Islands $70,539 $544,494 $699,816 - $1,314,849 

Ohio $9,818,808 $7,693,403 $29,813,666 $2,670,107.00 $49,995,984 

Oklahoma $3,061,821 $3,431,303 $10,673,197 $621,206.00 $17,787,527 

Oregon $3,165,797 $3,496,887 $10,967,729 $1,087,668.00 $18,718,081 

Palau $17,605 $511,104 $549,867 - $1,078,576 

Pennsylvania $10,642,275 $8,212,819 $32,146,289 - $51,001,383 

Puerto Rico $3,359,999 $3,619,384 $11,517,842 - $18,497,225 

Rhode Island $913,283 $2,076,070 $4,587,048 - $7,576,401 

South Carolina $3,696,593 $3,831,697 $12,471,312 - $19,999,602 

South Dakota $668,889 $1,921,915 $3,894,757 - $6,485,561 

Tennessee $5,165,868 $4,758,470 $16,633,313 - $26,557,651 

Texas $20,109,629 $14,184,535 $58,964,392 - $93,258,556 

Utah $2,181,440 $2,875,985 $8,179,349 $1,320,501.00 $14,557,275 

Vermont $533,720 $1,836,654 $3,511,863 - $5,882,237 

Virgin Islands (U.S) $92,905 $558,602 $763,173 - $1,414,680 

Virginia $6,538,072 $5,624,014 $20,520,344 - $32,682,430 

Washington $5,471,257 $4,951,101 $17,498,388 - $27,920,746 

West Virginia $1,555,603 $2,481,226 $6,406,542 - $10,443,371 

Wisconsin $4,753,288 $4,498,228 $15,464,604 - $24,716,120 

Wyoming $440,557 $1,777,890 $3,247,965 - $5,466,412 

TOTAL $260,000,000 $248,000,000 $846,000,000 $49,778,642.00 $1,403,778,642 

1

PHER grant funding was distributed in phases. Phase I funding was awarded to help assess current capabilities in pandemic influenza response and 

to address remaining gaps in vaccination, antiviral distribution/dispensing and administration, and community mitigation activities as well as 

laboratory, epidemiology, and surveillance activities. 

2 Phase II funding was awarded to provide additional resources for mass vaccination planning and implementation preparedness activities. Phase II 

funding also could be used for vaccine delivery, vaccine administration, and related communications planning and implementation. 

3 Phase III funding was awarded for implementation of the 2009 H1N1 influenza mass vaccination campaign. 

4 Phase IV funding was awarded to 15 states and localities to complete their H1N1 vaccination programs, specifically targeting high-risk populations, 

minority and hard-to-reach populations, and underserved and vulnerable populations that may have been unable to access vaccination services 

previously.

Source: CDC, OPHPR (DSLR)
178 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 6

Appendix 6: Cities Readiness Initiative Technical 

Assistance Review Scores for 2007-2008

The Cities Readiness Initiative (CRI) of CDC’s Strategic National Stockpile focuses on enhancing 

preparedness in the nation’s major metropolitan statistical areas (MSAs) where more than 50% of 

the U.S. population resides. Through CRI, state and large metropolitan public health departments 

have developed plans to respond to a large-scale bioterrorist event within 48 hours. The initial 

CRI planning scenario was based on a response to a large-scale anthrax attack. Through continued 

analysis and lessons learned, it became apparent that CRI MSAs needed to be better prepared to 

also respond to other public health emergencies. The Pandemic and All-Hazards Preparedness Act 

(PAHPA) of 2006 (P.L. 109-417) emphasizes an all-hazards approach to public health preparedness 

planning. 

The CRI project began in 2004 with 21 cities and expanded to a total of 72 MSAs, with at least one 

MSA in every state. Occasionally, MSAs extend across state borders, resulting in the representation 

of several states within one MSA. 

MSAs can be composed of one or more jurisdictions (e.g., counties, cities, and municipalities). 

Annual technical assistance reviews (TARs) are conducted in each jurisdiction to ensure continued 

readiness. CDC is responsible for conducting 25% of the TARs (see scores with asterisks) while the 

state is responsible for the other 75%. On a scale of 0 to 100, a TAR score of 69 or higher indicates 

that a jurisdiction performed within an acceptable range. The scores for each jurisdiction are 

combined to compute an average score for the entire MSA. The average MSA scores and individual 

jurisdiction scores for 2007-2008 are provided in Table 1 for each of the 72 MSAs. 

For more information on CRI, including TAR scores for 2008-09, see www.emergency.cdc.gov/cri.

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

Alabama (AL) 

Birmingham: 32

 Bibb County, AL: 32*

Blount County, AL: 32*

Chilton County, AL: 33*

Jefferson County, AL: 33*

St. Clair County, AL: 31*

Shelby County, AL: 30*

Walker County, AL: 33*

Alaska (AK) 

Anchorage: 74

Anchorage Municipality, AK: 74*

Matanuska-Susitna Borough, AK: No Score

Arizona (AZ) 

Phoenix: 72 

Maricopa County, AZ: 92*

 Pinal County, AZ: 52*

Arkansas (AR) 

Little Rock: 51

Faulkner County, AR: 36*

Grant County, AR: 69

Lonoke County, AR: 43

Perry County, AR: 34

Pulaski County, AR: 63*

Saline County, AR: 59

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

California (CA) 

Fresno: 22 Fresno County, CA: 22*

California (CA) 

Los Angeles: 82

Los Angeles County, CA: 81*

Orange County, CA: 82

California (CA) 

Riverside: 73

Riverside County, CA: 91

San Bernardino County, CA: 54

California (CA) 

Sacramento: 60 

El Dorado County, CA: 81

Placer County, CA: 38

Sacramento County, CA: 40*

Yolo County, CA: 80

California (CA) 

San Diego: 82 San Diego County, CA: 82

California (CA) 

San Francisco: 74

Alameda County, CA: 91

Contra Costa County, CA: 68

Marin County, CA: 71

San Francisco County, CA: 69

San Mateo County, CA: 73

Table 1: CRI Technical Assistance Review (TAR) Scores by Metropolitan Statistical Area (MSA); 2007-2008

*CDC conducted the TAR
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 179 Appendix 6

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

California (CA) 

San Jose: 77

San Benito County, CA: 81

Santa Clara County, CA: 73*

Colorado (CO) 

Denver: 90

Boulder County, CO: 89

Adams County, CO: 87*

Arapahoe County, CO: 87*

Broomfield County, CO: 87

Clear Creek County, CO: 95

Denver County, CO: 90*

Douglas County, CO: 87*

Elbert County, CO: 91

Gilpin County, CO: 96

Jefferson County, CO: 96

Park County, CO: 79

Connecticut (CT) 

Hartford: 42

Hartford County, CT: 42

Middlesex County, CT: 42

Tolland County, CT: 42

Connecticut (CT) 

New Haven: 70 New Haven County, CT: 70

Delaware (DE) 

Dover: 97 Kent County, DE: 97*

Florida (FL) 

Miami: 87

Broward County, FL: 78*

Miami-Dade County, FL: 93*

Palm Beach County, FL: 91

Florida (FL) 

Orlando: 81

Lake County, FL: 89

Orange County, FL: 86*

Osceola County, FL: 71

Seminole County, FL: 77*

Florida (FL) 

Tampa: 87

Hernando County, FL: 90*

Hillsborough County, FL: 89

Pasco County, FL: 81*

Pinellas County, FL: 86

Georgia (GA) 

Atlanta: 59

Barrow County, GA: 40*

Bartow County, GA: 100

Butts County, GA: 24*

Carroll County, GA: 24*

Cherokee County, GA: 78

Clayton County, GA: 82

Cobb County, GA: 92

Coweta County, GA: 24*

Dawson County, GA: 88

DeKalb County, GA: 56*

Douglas County, GA: 92

Fayette County, GA: 24*

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

(continued)

Georgia (GA) 

Atlanta: 59

Forsyth County, GA: 88

Fulton County, GA: 27*

Gwinnett County, GA: 89

Haralson County, GA: 100

Heard County, GA: 24*

Henry County, GA: 24*

Jasper County, GA: 93

Lamar County, GA: 24*

Meriwether County, GA: 24*

Newton County, GA: 89

Paulding County, GA: 100

Pickens County, GA: 78

Pike County, GA: 24*

Rockdale County, GA: 89

Spalding County, GA: 24*

Walton County, GA: 40*

Hawaii (HI) 

Honolulu: 51 Honolulu County, HI: 51*

Idaho (ID) 

Boise: 75

 Ada County, ID: 75*

Boise County, ID: 75*

Canyon County, ID: 75

Gem County, ID: 75

Owyhee County, ID: 75

Illinois (IL) 

Chicago: 80

City of Chicago, IL: 94*

Cook County, IL: 77*

DeKalb County, IL: 77

DuPage County, IL: 92*

Grundy County, IL: 64

Kane County, IL: 93*

Kendall County, IL: 71

Lake County, IL: 95

McHenry County, IL: 80

Will County, IL: 99

Jasper County, IN: 66

Lake County, IN: 52

Newton County, IN: 64

Porter County, IN: 91

Kenosha County, WI: 78

Illinois (IL) 

Peoria: 59

Marshall County, IL: 52

Peoria County, IL: 46*

Stark County, IL: 75

Tazewell County, IL: 69

Woodford County, IL: 54

*CDC conducted the TAR
180 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 6

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

Indiana (IN) 

Indianapolis: 83

Boone County, IN: 69

Brown County, IN: 91

Hamilton County, IN: 89*

Hancock County, IN: 86

Hendricks County, IN: 86

Johnson County, IN: 86

Marion County, IN: 95*

Morgan County, IN: 68

Putnam County, IN: 74

Shelby County, IN: 89

Iowa (IA) 

Des Moines: 54

Dallas County, IA: 67

Guthrie County, IA: 48

Madison County, IA: 35

Polk County, IA: 85

Warren County, IA: 33

Kansas (KS) 

Wichita: 59

Butler County, KS: 53*

Harvey County, KS: 51

Sedgwick County, KS: 80

Sumner County, KS: 51

Kentucky (KY) 

Louisville: 68

Bullitt County, KY: 54

Henry County, KY: 75

Jefferson County, KY: 53*

Meade County, KY: 75

Nelson County, KY: 75

Oldham County, KY: 61*

Shelby County, KY: 75

Spencer County, KY: 75

Trimble County, KY: 75

Clark County, IN: 91

Floyd County, IN: 56

Harrison County, IN: 43

Washington County, IN: 70

Louisiana (LA) 

Baton Rouge: 

No Score

Ascension Parish, LA: No Score

East Baton Rouge Parish, LA: No Score

East Feliciana Parish, LA: No Score

Iberville Parish, LA: No Score

Livingston Parish, LA: No Score

Pointe Coupee Parish, LA: No Score

St. Helena Parish, LA: No Score

West Baton Rouge Parish, LA: No Score

West Feliciana Parish, LA: No Score

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

Louisiana (LA) 

New Orleans: 

No Score

Jefferson Parish, LA: No Score

Orleans Parish, LA: No Score

Plaquemines Parish, LA: No Score

St. Bernard Parish, LA: No Score

St. Charles Parish, LA: No Score

St. John the Baptist Parish, LA: No Score

St. Tammany Parish, LA: No Score

Maine (ME) 

Portland: 25

Cumberland County, ME: 25*

Sagadahoc County, ME: 25*

York County, ME: 25*

Maryland (MD) 

Baltimore: 77

Anne Arundel County, MD: 86

Baltimore County, MD: 74*

Carroll County, MD: 85

Harford County, MD: 79

Howard County, MD: 75

Queen Anne’s County, MD: 81

Baltimore City, MD: 58*

National Capitol 

Region: 82

Calvert County, MD: 81

Charles County, MD: 80

Frederick County, MD: 96

Montgomery County, MD: 86*

Prince George’s County, MD: 79*

Arlington County, VA: 86

Clarke County, VA: 82

Fairfax County, VA: 94*

Fauquier County, VA: 77

Loudoun County, VA: 91

Prince William County, VA: 62

Spotsylvania County, VA: 94*

Stafford County, VA: 94*

Warren County, VA: 82

Alexandria City, VA: 94

Fairfax City, VA: 94*

Falls Church City, VA: 94*

Fredericksburg City, VA: 94*

Manassas City, VA: 62

Manassas Park City, VA: 62

Jefferson County, WV: 29

*CDC conducted the TAR
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 181 Appendix 6

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

Massachusetts

(MA) 

Boston: 76

Essex County, MA: 72

Norfolk County, MA: 76

Plymouth County, MA: 83

Suffolk County, MA: 84*

Middlesex County, MA: 76

Rockingham County, NH: 48

Strafford County, NH: 90

Michigan (MI) 

Detroit: 78

City of Detroit, MI: 78*

Wayne County, MI: 46*

Lapeer County, MI: 76

Livingston County, MI: 86

Macomb County, MI: 80*

Oakland County, MI: 93

St. Clair County, MI: 90

Minnesota (MN) 

Minneapolis: 79

City of Minneapolis, MN: 89*

Anoka County, MN: 92

Carver County, MN: 74

Chisago County, MN: 69

Dakota County, MN: 86

Hennepin County, MN: 94*

Isanti County, MN: 50

Ramsey County, MN: 79*

Scott County, MN: 80

Sherburne County, MN: 65

Washington County, MN: 74

Wright County, MN: 85

Pierce County, WI: 87

St. Croix County, WI: 82

Mississippi (MS) 

Jackson: 88

Copiah County, MS: 88*

Hinds County, MS: 88*

Madison County, MS: 88*

Rankin County, MS: 88*

Simpson County, MS: 88*

Missouri (MO) 

Kansas City: 73

Kansas City Proper, MO: 80*

Bates County, MO: 74

Caldwell County, MO: 87

Cass County, MO: 77

Clay County, MO: 78*

Clinton County, MO: 88

Jackson County, MO: 48*

Lafayette County, MO: 84

Platte County, MO: 77

Ray County, MO: 80

Franklin County, KS: 47

Johnson County, KS: 71*

Leavenworth County, KS: 76

Linn County, KS: 67

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

(continued)

Missouri (MO) 

Kansas City: 73

Miami County, KS: 43

Wyandotte County: 87*

Missouri (MO) 

St. Louis: 76

Crawford County, MO: No Score

Franklin County, MO: 78

Jefferson County, MO: 84

Lincoln County, MO: 79

St. Charles County, MO: 77*

St. Louis County, MO: 85*

Warren County, MO: 67

Washington County, MO: 91

St. Louis city, MO: 75*

Bond County, IL: 89

Calhoun County, IL: 78

Clinton County, IL: 88

Jersey County, IL: 70

Macoupin County, IL: 47

Madison County, IL: 57*

Monroe County, IL: 78

St. Clair County, IL: 73*

Montana (MT) 

Billings: 80

Carbon County, MT: No Score

Yellowstone County, MT: 80*

Nebraska(NE) 

Omaha: 44

Cass County, NE: 33

Dodge County, NE: 41

Douglas County, NE: 51*

Sarpy County, NE: 33

Saunders County, NE: 41

Washington County, NE: 41

Harrison County, IA: 58

Mills County, IA: 49

Pottawattamie County, IA: 49

Nevada (NV) 

Las Vegas: 82 Clark County, NV: 82*

New 

Hampshire (NH) 

Manchester: 75

Hillsborough County, NH: 75*

New Jersey (NJ) 

Trenton: 78 Mercer County, NJ: 78

New Mexico (NM) 

Albuquerque: 26

City of Albuquerque, NM: No Score

Bernalillo County, NM: 26*

Sandoval County, NM: 26*

Torrance County, NM: 26*

Valencia County, NM: 26*

New York (NY) 

Albany: 92

Albany County, NY: 99*

Rensselaer County, NY: 81*

Saratoga County, NY: 91

Schenectady County, NY: 96

Schoharie County, NY: 91

*CDC conducted the TAR
182 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 6

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

New York (NY) 

Buffalo: 85

Erie County, NY: 91

Niagara County, NY: 79*

New York (NY) 

New York City: 86

Bronx County, NY: 99*

Kings County, NY: 99*

New York County, NY: 99*

Queens County, NY: 99*

Richmond County, NY: 99*

Nassau County, NY: 98

Putnam County, NY: 95

Rockland County, NY: 88*

Suffolk County, NY: 91

Westchester County, NY: 77*

Bergen County, NJ: 82

Essex County, NJ: 76

Hudson County, NJ: 89

Hunterdon County, NJ: 86

Middlesex County, NJ: 89*

Monmouth County, NJ: 83*

Morris County, NJ: 87

Ocean County, NJ: 74

Passaic County, NJ: 71

Somerset County, NJ: 76

Sussex County, NJ: 98

Union County, NJ: 82*

Pike County, PA: 40

North 

Carolina (NC) 

Charlotte: 63

Anson County, NC: 83

Cabarrus County, NC: 85

Gaston County, NC: 46

Mecklenburg County, NC: 60*

Union County, NC: 42

York County, SC: 60*

North Dakota 

(ND) 

Fargo: 70

Cass County, ND: 78*

Clay County, MN: 62*

Ohio (OH) 

Cincinnati: 62

City of Cincinnati, OH: 94

Brown County, OH: 71

Butler County, OH: 56*

Clermont County, OH: 76*

Hamilton County, OH: 66

Warren County, OH: 37*

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

(continued)

Ohio (OH) 

Cincinnati: 62

Boone County, KY: 58

Bracken County, KY: 52

Campbell County, KY: 58

Gallatin County, KY: 43

Grant County, KY: 58

Kenton County, KY: 58

Pendleton County, KY: 43

Dearborn County, IN: 89

Franklin County, IN: 61

Ohio County, IN: 75

Ohio (OH) 

Cleveland: 71

City of Cleveland, OH: 92

Cuyahoga County, OH: 81

Geauga County, OH: 69

Lake County, OH: 67*

Lorain County, OH: 68*

Medina County, OH: 46*

Ohio (OH) 

Columbus: 52

Delaware County, OH: 24*

Fairfield County, OH: 54*

Franklin County, OH: 78

Licking County, OH: 36*

Madison County, OH: 57

Morrow County, OH: 54

Pickaway County, OH: 56

Union County, OH: 56

Oklahoma (OK) 

Oklahoma City: 

79 

Canadian County, OK: 90

Cleveland County, OK: 91*

Grady County, OK: 79

Lincoln County, OK: 86

Logan County, OK: 86

McClain County, OK: 91*

Oklahoma County, OK: 35*

Pottawatomie County, OK: 77

Oregon (OR) 

Portland: 58

Clackamas County, OR: 37*

Columbia County, OR: 50

Multnomah County, OR: 65*

Washington County, OR: 68

Yamhill County, OR: 65

Clark County, WA: 59*

Skamania County, WA: 59*

*CDC conducted the TAR
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 183 Appendix 6

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

Pennsylvania (PA) 

Philadelphia: 75

Bucks County, PA: 82

Chester County, PA: 49

Delaware County, PA: 89

Montgomery County, PA: 35*

Philadelphia County, PA: 98*

New Castle County, DE: 97*

Cecil County, MD: 58*

Burlington County, NJ: 81

Camden County, NJ: 77

Gloucester County, NJ: 88*

Salem County, NJ: 76

Pennsylvania (PA) 

Pittsburgh: 42

Allegheny County, PA: 42*

Armstrong County, PA: 42*

Beaver County, PA: 42*

Butler County, PA: 42*

Fayette County, PA: 42*

Washington County, PA: 42*

Westmoreland County, PA: 42*

Rhode Island, (RI) 

Providence: 89

Bristol County, RI: 89*

Kent County, RI: 89*

Newport County, RI: 89*

Providence County, RI: 89*

Washington County, RI: 89*

Bristol County, MA: 89*

South Carolina 

(SC) 

Columbia: 83

Calhoun County, SC: 83*

Fairfield County, SC: 83*

Kershaw County, SC: 83*

Lexington County, SC: 83*

Richland County, SC: 83*

Saluda County, SC: 83*

Newberry County, SC: No Score

South Dakota (SD) 

Sioux Falls: 74

Lincoln County, SD: 74*

McCook County, SD: 74*

Minnehaha County, SD: 74*

Turner County, SD: 74*

Tennessee (TN) 

Memphis: 72

Fayette County, TN: 60

Shelby County, TN: 59*

Tipton County, TN: 60

Crittenden County, AR: 47

DeSoto County, MS: 87*

Marshall County, MS: 87*

Tate County, MS: 87*

Tunica County, MS: 87*

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

Tennessee (TN) 

Nashville: 56

Cannon County, TN: 56*

Cheatham County, TN: 56*

Davidson County, TN: 56*

Dickson County, TN: 56*

Hickman County, TN: 56*

Macon County, TN: 56*

Robertson County, TN: 56*

Rutherford County, TN: 56*

Smith County, TN: 56*

Sumner County, TN: 56*

Trousdale County, TN: 56*

Williamson County, TN: 56*

Wilson County, TN: 56*

Texas (TX) 

Dallas: 91

Collin County, TX: 95*

Dallas County, TX: 100*

Delta County, TX: 91

Denton County, TX: 98*

Ellis County, TX: 79

Hunt County, TX: 91

Johnson County, TX: 84

Kaufman County, TX: 87

Parker County, TX: 93

Rockwall County, TX: 87

Tarrant County, TX: 98*

Wise County, TX: 89

Texas (TX) 

Houston: 79

City of Houston, TX: 70*

Austin County, TX: 67

Brazoria County, TX: 83

Chambers County, TX: 86

Fort Bend County, TX: 83*

Galveston County, TX: 82

Harris County, TX: 93*

Liberty County, TX: 65

Montgomery County, TX: 86*

San Jacinto County, TX: 94

Waller County, TX: 65

Texas (TX) 

San Antonio: 55

Atascosa County, TX: 43

Bandera County, TX: 43

Bexar County, TX: 85*

Comal County, TX: 85

Guadalupe County, TX: 45*

Kendall County, TX: 43

Medina County, TX: 56

Wilson County, TX: 43

*CDC conducted the TAR
184 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 6

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

Utah (UT) 

Salt Lake City: 68

Salt Lake County, UT: 68*

Summit County, UT: No Score

Tooele County, UT: No Score

Vermont (VT) 

Burlington: 70

Chittenden County, VT: 70*

Franklin County, VT: 70*

Grand Isle County, VT: 70*

Virginia (VA) 

Richmond: 89

Amelia County, VA: 89

Caroline County, VA: 94*

Charles City County, VA: 88

Chesterfield County, VA: 95*

Cumberland County, VA: 89

Dinwiddie County, VA: 87

Goochland County, VA: 88

Hanover County, VA: 88

Henrico County, VA: 88

King and Queen County, VA: 96*

King William County, VA: 96*

Louisa County, VA: 70

New Kent County, VA: 88

Powhatan County, VA: 95*

Prince George County, VA: 87

Sussex County, VA: 87

Colonial Heights City, VA: 95*

Hopewell City, VA: 87

Petersburg City, VA: 87

Richmond City, VA: 85

Virginia (VI) 

Virginia Beach: 

86

Accomack County, VA: 90*

Gloucester County, VA: 96*

Isle of Wight County, VA: 69

MSA and MSA 

TAR Score

Jurisdiction(s) within MSA and 

Individual Jurisdiction TAR Score

(continued)

Virginia (VI) 

Virginia Beach: 

86

James City County, VA: 91*

*Mathews County, VA: 96*

Northampton County, VA: 90*

Surry County, VA: 87

York County, VA: 91*

Chesapeake City, VA: 89

Hampton City, VA: 77

Newport News City, VA: 91*

Norfolk City, VA: 76

Poquoson City, VA: 91*

Portsmouth City, VA: 82

Suffolk City, VA: 69

Virginia Beach City, VA: 92

Williamsburg City, VA: 91*

Currituck County, NC: 77

Washington (WA) 

Seattle: 68

King County, WA: 87*

Snohomish County, WA: 44*

Pierce County, WA: 73

West Virginia (WV)

Charleston: 50

Boone County, WV: 36

Clay County, WV: 41*

Kanawha County, WV: 70*

Lincoln County, WV: 60

Putnam County, WV: 43

Wisconsin (WI) 

Milwaukee: 79

City of Milwaukee, WI: 72*

Milwaukee County, WI: 72*

Ozaukee County, WI: 89

Washington County, WI: 88

Waukesha County, WI: 73

Wyoming (WY) 

Cheyenne: 49 Laramie County, WY: 49*

*CDC conducted the TAR

Directly Funded Localities and Locality Scores

Chicago (City of), IL: 94*

District of Columbia: 94*

Los Angeles County, CA: 81*

New York City, NY: 99*

(includes Bronx, Kings, New York, Queens and Richmond County)
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 185 Appendix 7

Appendix 7: Data Sources

Data presented in this report come from a variety of sources. The purpose of this appendix is to 

provide additional details about data sources for the programs and/or activities referenced in this 

report. For ease of use, the data sources are listed within the categories used in the tables and 

fact sheets. Please see appendix 2 for additional background information on the CDC organizations 

listed in the sources below. 

CDC

Chronic Conditions

Behavioral Risk Factor Surveillance System (BRFSS) state data, 2008; CDC, Office of 

Noncommunicable Diseases, Injury and Environmental Health (ONCDIEH), National Center for 

Chronic Disease Prevention and Health Promotion (NCCDPHP). Heart disease data includes two 

BRFSS cardiovascular disease questions: Ever told you had a heart attack OR Ever told you had 

angina or coronary heart disease. 

Behavioral Risk Factor Surveillance System (BRFSS) data for selected Metropolitan/Micropolitan 

Area Risk Trends (SMART), 2008; CDC, Office of Noncommunicable Diseases, Injury and 

Environmental Health (ONCDIEH), National Center for Chronic Disease Prevention and Health 

Promotion (NCCDPHP). Heart disease data includes two BRFSS SMART cardiovascular disease 

questions: Ever told you had a heart attack OR Ever told you had angina or coronary heart disease. 

Laboratories: General

Laboratory Response Network (LRN) standard electronic data mechanism for messaging data, as of 

9/30/2008; CDC, Office of Surveillance, Epidemiology, and Laboratory Services (OSELS)

Laboratories: Biological Capabilities

Laboratory Response Network (LRN) biological laboratory CDC Emergency Operations Center 

contact drill data, 3/2008; CDC, Office of Infectious Diseases (OID), National Center for Emerging 

and Zoonotic Infectious Diseases (NCEZID)

Laboratory Response Network (LRN) biological laboratory testing performance measure data, 

8/31/2007-8/9/2008; CDC, Office of Public Health Preparedness and Response (OPHPR), Division 

of State and Local Readiness (DSLR)

Laboratory Response Network (LRN) biological laboratory proficiency testing data, 1/2008-9/2008; 

CDC, Office of Infectious Diseases (OID), National Center for Emerging and Zoonotic Infectious 

Diseases (NCEZID)

Laboratory Response Network (LRN) biological laboratory testing capability data, as of 9/30/2008; 

CDC, Office of Infectious Diseases (OID), National Center for Emerging and Zoonotic Infectious 

Diseases (NCEZID)

Laboratory Response Network (LRN) non-business hours telephone contact drill data, 8/2008; CDC, 

Office of Infectious Diseases (OID), National Center for Emerging and Zoonotic Infectious Diseases 

(NCEZID)
186 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Appendix 7

Laboratories: Chemical Capabilities

Laboratory Response Network (LRN) chemical laboratory capabilities and proficiency testing data, 

as of 9/14/2009; CDC, Office of Noncommunicable Diseases, Injury and Environmental Health 

(ONDIEH), National Center for Environmental Health (NCEH)

Laboratory Response Network (LRN) chemical laboratory collect, package, and ship samples 

exercise data, as of 11/9/2009; CDC, Office of Noncommunicable Diseases, Injury and 

Environmental Health (ONDIEH), National Center for Environmental Health (NCEH)

Laboratory Response Network (LRN) chemical laboratory Emergency Response Pop Proficiency 

Test (PopPT) exercise data, as of 8/31/2008; CDC, Office of Noncommunicable Diseases, Injury and 

Environmental Health (ONDIEH), National Center for Environmental Health (NCEH)

Laboratory Response Network (LRN) chemical laboratory Surge Capacity exercise data, 1/9/2009; 

CDC, Office of Noncommunicable Diseases, Injury and Environmental Health (ONDIEH), National 

Center for Environmental Health (NCEH)

Response Readiness: Communication

Epi-X data, 4/3/2008; CDC, Office of Public Health Preparedness and Response (OPHPR), Division 

of Emergency Operations (DEO)

Health Alert Network data, 7/2009; CDC, Office of Public Health Preparedness and Response 

(OPHPR), Division of Emergency Operations (DEO)

Public Health Information Network forum (community of practice) data, as of 9/30/2008; CDC, 

Office for State, Tribal, Local and Territorial Support (OSTLTS)

Reporting capacity system data, 10/1/2007-9/30/2008; state and locality data

Response Readiness: Planning

CHEMPACK data, as of 7/30/2008; CDC, Office of Public Health Preparedness and Response 

(OPHPR), Division of Strategic National Stockpile (DSNS)

Cities Readiness Initiative (CRI) 2007-2008 technical assistance review score data, as of 8/9/2008; 

CDC, Office of Public Health Preparedness and Response (OPHPR), Division of Strategic National 

Stockpile (DSNS).

State technical assistance review score data, 2006-2007 scores as of 12/2007; 2007-2008 scores 

are associated with funding from the PHEP cooperative agreement Budget Period 8 (8/31/07-

8/9/08), and 2008-2009 scores are associated with funding from the PHEP cooperative agreement 

Budget Period 9 (8/10/2008-8/9/2009); CDC, Office of Public Health Preparedness and Response 

(OPHPR), Division of Strategic National Stockpile (DSNS) 

Response Readiness: Exercises and Incidents

Emergency operations center staff notification and activation performance measure data, 

8/31/2007-8/9/2008; CDC, Office of Public Health Preparedness and Response (OPHPR), Division 

of State and Local Readiness (DSLR) 
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 187 Appendix 7

Response Readiness: Evaluation

After action report/improvement plan performance measure data, 8/31/2007-8/9/2008; CDC, Office 

of Public Health Preparedness and Response (OPHPR), Division of State and Local Readiness (DSLR)

Research, Training, Education, and Promising Demonstration Projects

Centers for Public Health Preparedness (CPHP) data, fiscal year 2008 awards for activities/projects 

conduced in fiscal year 2009; CDC, Office of Public Health Preparedness and Response (OPHPR), 

Office of the Director (OD)

Centers of Excellence in Public Health Informatics data, fiscal year 2008 awards for activities/

projects conducted in fiscal year 2009; CDC, Office of Surveillance, Epidemiology, and Laboratory 

Services (OSELS)

Pandemic Influenza Promising Practices Demonstration Project(s) data, fiscal year 2008 awards for 

activities/projects conducted in fiscal year 2009; CDC, Office of Public Health Preparedness and 

Response (OPHPR), Division of State and Local Readiness (DSLR)

Preparedness and Emergency Response Research Center (PERRC) data, fiscal year 2008 awards for 

activities/projects conducted in fiscal year 2009; CDC, Office of Public Health Preparedness and 

Response (OPHPR), Office of the Director (OD)

 Additional CDC Resources Supporting Preparedness in States and Localities

Career Epidemiology Field Officer (CEFO) data, as of 9/30/2008; CDC, Office of Public Health 

Preparedness and Response (OPHPR), Office of the Director (OD)

Epidemic Intelligence Service (EIS) data, 10/1/2007-9/30/2008; CDC, Office of Surveillance, 

Epidemiology, and Laboratory Services (OSELS)

Deployment data, 10/1/2007-9/30/2008; CDC, Office of Public Health Preparedness and Response 

(OPHPR), Division of Emergency Operations (DEO)

Quarantine and Migration Health System data, 10/1/2007-9/30/2008; CDC, Office of Infectious 

Diseases (OID), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)

Association of Public Health Laboratories (APHL)

Biological laboratory competency assessment exercise data, 8/31/2007-8/30/2008; Association of 

Public Health Laboratories 

Continuity of operations plan (COOP) for state public health laboratories data, 8/31/2007-

8/30/2008; Association of Public Health Laboratories 

Laboratory usage of HAN or other rapid communication methods data, 8/31/2007-8/30/2008; 

Association of Public Health Laboratories

National Association of County and City Health Officials (NACCHO)

Advanced Practice Center (APC) data, fiscal year 2008 awards for activities/projects conducted in 

fiscal year 2009; National Association of County and City Health Officials

Project Public Health Ready data, as of 9/30/2008; National Association of County and City 

Health Officials
188 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Endnotes

Endnotes 

 1 The U.S. insular areas as defined by the U.S. Department of the Interior/Office of Insular Affairs 

are comprised of the three territories of American Samoa, Guam, and the U.S. Virgin Islands; the 

two commonwealths of the Northern Mariana Islands and Puerto Rico; and three freely associated states of the Federated States of Micronesia, the Republic of the Marshall Islands, and the 

Republic of Palau. More information on insular areas is available at www.doi.gov/oia/index.html.

 2 The two previous CDC preparedness reports are the following:

Public Health Preparedness: Mobilizing State By State; CDC, Office of Public Health 

Preparedness and Response (formerly the Coordinating Office for Terrorism Preparedness 

and Emergency Response), Published in 2008, this report highlights progress and identifies 

challenges in state and local preparedness and response, and presents national data and statespecific snapshots for 50 states and 4 localities: Chicago, Los Angeles County, New York City, 

and Washington, DC. Available at www.emergency.cdc.gov/publications/feb08phprep/.

Public Health Preparedness: Strengthening CDC’s Emergency Response; CDC, Office of Public 

Health Preparedness and Response (formerly the Coordinating Office for Terrorism Preparedness and Emergency Response). Published in 2009, this report describes all activities supported 

by the Terrorism Preparedness and Emergency Response funding, which includes the Public 

Health Emergency Preparedness (PHEP) cooperative agreement. Available at www.emergency.

cdc.gov/publications/jan09phprep/.

 3 CDC’s 2009 preparedness report (see note 2) was commended by the House and Senate 

Appropriations committees for FY 2010. U.S. House. Committee on Appropriations. 

Departments of Labor, Health and Human Services, and Education, and Related Agencies 

Appropriation Bill, 2010. 111th Cong., 1st sess., 2009. H. Rept. 111-220. U.S. Senate. 

Committee on Appropriations. Departments of Labor, Health and Human Services, and 

Education, and Related Agencies Appropriation Bill, 2010. 111th Cong., 1st sess., 2009. S. Rept. 

111-66. Both available at thomas.loc.gov/home/LegislativeData.php?&n=Reports&c=111.

 4 See note 2.

 5 References to CDC also apply to the Agency for Toxic Substances and Disease Registry (ATSDR) 

and the National Institute for Occupational Safety and Health (NIOSH).

 6 See note 1.

 7 Originally established in 2002 as the Office for Terrorism Preparedness and Emergency 

Response (OTPER) and renamed the Coordinating Office for Terrorism Preparedness and 

Emergency Response (COTPER) in 2005 during a CDC reorganization. In 2009, the name of the 

office was changed to Office of Public Health Preparedness and Response (OPHPR) as part of 

CDC’s organizational improvement.

 8 See note 2. 

 9 The number of data points on each state fact sheet increased from 26 in CDC’s 2008 

preparedness report to 42 in this report, in addition to state-specific information on an 

additional 10 CDC-funded resources and projects to support state and local preparedness.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 189 Endnotes

10 CDC preparedness reports do not discuss broader national disaster management or medical 

response activities conducted by the Federal Emergency Management Agency, the Office of the 

Assistant Secretary for Preparedness and Response (e.g., Hospital Preparedness Program), and 

others.

11 National Health Security Strategy (2009). More information available at www.hhs.gov/aspr/

opsp/nhss/strategy.html.

12 Pandemic and All-Hazards Preparedness Act, Pub. L. No. 109–417, 120 Stat. 2831 (December 

19, 2006). Available at www.hhs.gov/aspr/omsph/nbsb/publiclaw109417.pdf.

13 Institute of Medicine. The Future of Emergency Care in the United States Health System: 

Emergency Medical Services at the Crossroad.Washington DC: The National Academies Press; 

2006. Available at www.nap.edu/catalog.php?record_id=11629 (p.180).

14 See Note 11.

15 See note 12.

16 Drawing on the definition provided in the Pandemic and All-Hazards Preparedness Act (see 

note 12), HHS has adopted the following definition of at-risk individuals. The term “at-risk 

individuals” is interchangeable with terms like “special needs populations” and “vulnerable 

populations.” Before, during, and after an incident, members of at-risk populations may have 

additional needs in one or more of the following functional areas: maintaining independence, 

communication, transportation, supervision, and medical care. In addition to those individuals 

specifically recognized as at-risk in the statute, i.e., children, senior citizens, and pregnant women, individuals who may need additional response assistance include those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency 

or are non-English speaking, are transportation-disadvantaged, have chronic medical disorders, 

or have pharmacological dependency.

17 See note 5.

18 The National Response Framework, which replaced the National Response Plan in 2008, establishes a comprehensive, national, all-hazards approach to domestic incident response (www.

fema.gov/emergency/nrf/about NRF.htm). In addition, the National Preparedness Guidelines 

provide vision, capabilities, and priorities for national preparedness. These two documents 

constitute the core of the nation’s preparedness policies. 

19 As specified in Emergency Support Function #8 (ESF #8) – Public Health and Medical Services 

Annex of the National Response Framework. 

20 See note 11.

21 Institute of Medicine. Research Priorities in Emergency Preparedness and Response for 

Public Health Systems. A Letter Report. Washington, DC: The National Academies Press, 2008. 

Available at www.iom.edu/CMS/3740/48812/50685.aspx.

22 See note 1.

23 See note 12. 

24 The timeframe for fiscal year 2009 is October 1, 2008, through September 30, 2009.

25 See note 7. 
190 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Endnotes

26 The 62 state, locality, and U.S. insular areas funded by the PHEP cooperative agreement include 

all 50 states; the 4 localities of Chicago, District of Columbia, Los Angeles County, and New York 

City; and 8 U.S. insular areas (see note 1). Recipients of PHEP funds must demonstrate that a 

majority of all American Indian/Alaska Native tribes within their jurisdictions concur with the 

priorities and plans described in annual PHEP-funding applications. This helps ensure that tribal 

preparedness and response capacity needs are included in state plans. PAHPA has no provisions 

for direct funding to tribal nations.

27 Metropolitan statistical areas (MSAs) are composed of multiple counties and are defined by 

the U.S. Office of Management and Budget. More information is available at www.census.gov/

population/www/metroareas/metrodef.html.

28 Supplemental Appropriations Act, 2009. Available at www.gpo.gov/fdsys/pkg/PLAW-111-

publ32/content-detail.html.

29 Association of State and Territorial Health Officials, Job and Program Cuts Accelerate, Threaten 

the Public’s Health (2009). Available at www.astho.org/Display/AssetDisplay.aspx?id=2780.

30 National Association of County and City Health Officials, Local Health Department Job Losses 

and Program Cuts: Overview of Survey Findings from January/February 2010 Survey (March 

2010). Available at www.naccho.org/topics/infrastructure/lhdbudget/index.cfm.

31 See note 10. 

32 See note 2. 

33 See note 2.

34 As of 5/28/10, over 3000 mumps cases had been identified and efforts continued to contain 

the outbreak.

35 Association of State and Territorial Health Officials, Response to Incidents (2010). Available at 

www.astho.org/Advocacy/2010-Advocacy-Materials/Preparedness_Response_to_incidents/.

36 National Biosurveillance Strategy for Human Health (February 2010). Available at www.cdc.

gov/osels/pdf/NBSHH_V2_FINAL.PDF.

37 Council of State and Territorial Epidemiologists Epidemiology Capacity Assessment 2009. Available at www.cste.org. In addition, an article on this assessment is available in Morbidity and 

Mortality Weekly Report 2009; 58 (49):1373-1377. 

38 See note 35.

39 The possession, use, and transfer of biological agents and toxins that could pose a severe threat 

to public health and safety are regulated by CDC’s Select Agent Program.

40 CDC coordinates PulseNet, a national network of laboratories at state health departments, local 

health departments, and federal agencies. PulseNet is on the alert for both common bacteria 

that cause disease outbreaks (e.g., Salmonella), as well as agents that can be used in a bioterrorist attack through the food supply (e.g., Francisella). PulseNet member laboratories submit 

DNA fingerprints electronically to a dynamic database at CDC. Members can use the database 

to evaluate if outbreaks are natural or intentional and to help trace outbreaks to the source.

41 The acceptable threshold score increased to 79 or higher for 2009-2010.
Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State 191 Endnotes

42 The eight core ICS functional roles are Incident Commander, Public Information Officer, Safety Officer, 

Liaison Officer, Operations Section Chief, Planning Section Chief, Logistics Section Chief, and Finance/

Administration Section Chief.

43 In 2010, CDC established a 60 minute target for staff to assemble during an unannounced 

activation. CDC will report this measure to HHS and the President’s Office of Management and 

Budget as a high priority performance goal.

44 In 2009, CDC awarded another $2.7 million over 4 years to two additional schools of public 

health to establish Preparedness and Emergency Response Research Centers. 

45 See note 11.

46 See note 12.

47 See note 1 for general information on U.S. insular areas. Definitions of commonwealths, freely 

associated states, and territories are available at www.doi.gov/oia/Islandpages/political_types.htm.
192 Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State Endnotes

ACRONYMS

AAR/IP After Action Report/Improvement Plans

APC Advanced Practice Centers

APHL Association of Public Health Laboratories

ASPR Assistant Secretary for Preparedness and Response 

CDC Centers for Disease Control and Prevention

CEFO Career Epidemiology Field Officers

COOP Continuity of operations plan

CPHP Centers for Public Health Preparedness

CRI Cities Readiness Initiative 

DHS U.S. Department of Homeland Security

EIS Epidemic Intelligence Service

EOC Emergency operations center

Epi-X Epidemic Information Exchange

FY Fiscal year

HAN Health Alert Network

HHS U.S. Department of Health and Human Services 

ICS Incident Command System

LRN Laboratory Response Network

MSA Metropolitan statistical area

OPHPR Office of Public Health Preparedness and Response 

PAHPA Pandemic and All-Hazards Preparedness Act

PERRC Preparedness and Emergency Response Research Center

PHA Public health advisor

PFGE Pulsed-field gel electrophoresis

PHEP Public Health Emergency Preparedness cooperative agreement 

PHER Public Health Emergency Response grant

PopPT LRN Emergency Response Pop Proficiency Test 

TAR Technical assistance reviews

TPER Terrorism Preparedness and Emergency Response funding
Dedication

This report is 

dedicated to the 

memory of Diane 

Berry Caves, who 

lost her life during 

the January 12, 

2010 earthquake 

in Haiti while on a 

3-week assignment 

to improve Haitian 

HIV/AIDS programs. 

A dedicated public 

health professional, Diane led the development of 

the first CDC report on public health preparedness, lauded by many as innovative, and played 

integral roles in the strategic development of 

the two succeeding reports. These reports 

demonstrate accountability and drive program 

improvement for public health preparedness 

and response. 

In acknowledgement of her sacrifice, Diane was 

posthumously awarded the U.S. Department of 

State Thomas Jefferson Star for Foreign Service. 

This award recognizes people seriously injured or 

killed while traveling or serving abroad on official 

business. The award was signed by President 

Obama and bestowed by Secretary of State Clinton 

at a Memorial Ceremony in May 2010. CDC 

planted a Glory Maple tree in Diane’s honor at its 

headquarters in Atlanta, GA.
This report was developed by the Office of Public Health Preparedness and Response (OPHPR),

Centers for Disease Control and Prevention (CDC) 

Rear Admiral Ali S. Khan, MD, MPH

Director and Assistant Surgeon General

Daniel M. Sosin, MD, MPH, FACP

Deputy Director and Chief Medical Officer

Ann O’Connor, MPA

Associate Director for Policy

Project Team

Stacey Bloomer Brawner, MS

Denise Casey

Brian Rutter, MBA 

Monique Salter, MPH

Laurie Schnepf

Mina Zadeh, PhD

CDC Analytical and Data Support

OPHPR, Division of State and Local Readiness

Craig W. Thomas, PhD; Rich Ann Baetz, MSCRP; Michael Fanning, MPH

OPHPR, Division of Strategic National Stockpile 

Linda Neff, PhD; Jaime Jones, MPH

Program Service Consultants (see inside back cover)

Office of Infectious Diseases,

National Center for Emerging and Zoonotic Infectious Diseases 

Laura Jevitt, MPH; Jasmine Chaitram, MPH

Office of Noncommunicable Diseases, Injury and Environmental Health,

National Center for Environmental Health/Agency for Toxic Substances and Disease Registry

Robert Kobelski, PhD; Rachael Schmidt, MPH

Other CDC Contributors

Office for State, Tribal, Local and Territorial Support 

Office of Infectious Diseases 

Office of Noncommunicable Diseases, Injury and Environmental Health 

Office of Surveillance, Epidemiology, and Laboratory Services 

Subject Matter Experts Across CDC

Special Thanks

Association of Public Health Laboratories

Association of Schools of Public Health

Association of State and Territorial Health Officials

Council of State and Territorial Epidemiologists

National Association of County and City Health Officials

Report available at emergency.cdc.gov/publications/2010phprep

For more information on CDC’s preparedness and emergency response activities, visit the website of the Office of 

Public Health Preparedness and Response at emergency.cdc.gov/cdcpreparedness

CS215921-A