BMC Public Health 2006, 6:285 http://www.biomedcentral.com/1471-2458/6/285 Background State and local health departments throughout the United States are working to improve their ability to address the public health consequences of bioterrorism. The federal Centers for Disease Control and Prevention (CDC) and the Health Resources Services Administration (HRSA) are supporting these efforts, which are increasingly geared to preparing for a spectrum of public health emergencies, including different forms of terrorism, infectious disease epidemics such as pandemic influenza, and natural or environmental disasters[1-5]. Federal support includes both funding and technical assistance. Even with increased federal support, state and local gov- ernments will be unlikely to adequately manage a large- scale emergency response alone and must involve com- munity partners, including businesses. As was evident from Hurricane Katrina in 2005, businesses can provide essential resources to supplement government efforts [6,7]. These resources include supplies and inventories, storage facilities, distribution systems, vehicles, commu- nications links, and people with a mix of expertise and skills. While ad hoc engagement of businesses during a crisis can be invaluable, business involvement should preferably be based on prior collaboration with govern- ment agencies to develop and test emergency plans, including delineation of roles, responsibilities, and proce- dures for various components of response and recovery. Following the anthrax attacks of 2001, the National Busi- ness Group on Health surveyed selected large companies and public health leaders regarding their experience with collaboration. Survey responses revealed that opportuni- ties for business and public health partnerships were underdeveloped, in large part because personal relation- ships between business and public health leaders were limited. As a result, business and public health leaders lacked a working understanding of one another's capabil- ities and vulnerabilities and, thus, of optimal ways to engage in mutually beneficial collaborations [8,9]. The distribution and dispensing of supplies from the Stra- tegic National Stockpile (SNS) is a good example of an opportunity for business-public health partnerships. The SNS is a cache of emergency medications and supplies maintained by CDC, and state and local governments are responsible for receiving, distributing, and dispensing SNS supplies [10]. Under the Cities Readiness Initiative, the core planning scenario is a hypothetical, massive exposure to aerosolized anthrax [11]. CDC has charged state and local health departments with developing and testing procedures to administer post-exposure antibiotic prophylaxis to the population of a large urban area within 48 hours of an attack. This task presents a complex mix of logistic, medical, and communication challenges, exactly the kind of effort that could benefit from the combination of government and business human and material assets. In Georgia, public health officials and business leaders have been working for several years to develop a collabo- rative SNS dispensing model. Initially, the partnership involved the state's Division of Public Health, two local public health districts in the metropolitan Atlanta region, and the Georgia Business Force, an integral part of the Metro Atlanta Region of the Business Executives for National Security (BENS). As a national organization with offices in multiple regions of the country, BENS provides a "channel through which senior business executives can help enhance the nation's security" [12]. The purpose of its Business Force program is to build public-private part- nerships at state or regional levels "to help close gaps in homeland security that neither government, nor business, can fill alone"[13]. BENS is a non-partisan, not-for-profit 501(c)(3) tax-exempt organization [14], which is under- written primarily by individual and corporate member- ship fees and corporate donations, and the Georgia Business Force is an alliance of businesses within the Atlanta Metro Region of BENS. For brevity, we will use the abbreviation "BENS" to refer interchangeably to the Metro Atlanta Region of BENS and its Georgia Businesses Force. The SNS dispensing project is part of broader BENS col- laborations with public health, public safety, and home- land security agencies in Georgia aimed at enhancing all hazards emergency preparedness. The SNS project grew from contacts between BENS and public health leaders that had been established through prior collaboration on state homeland security committees and in developing a primer for businesses on bioterrorism and emergency pre- paredness [15]. In July 2005, the Georgia partners tested their SNS dis- pensing model in exercises at three sites, including two school-based sites managed by local public health offi- cials and one company-based site managed primarily by business volunteers. BENS members recruited approxi- mately 1,200 volunteers from their companies to serve as exercise evaluators and mock patients. The exercise suc- cessfully stressed procedures for staging the sites and mass dispensing, identified strengths and weaknesses in the dis- pensing model, and led to substantial revisions in plans for future dispensing. At present (November 2006), plan- ning is underway to involve company-based and public health-managed distribution sites in all five health dis- tricts in metropolitan Atlanta in further SNS dispensing exercises (for additional information on the history of the BENS-public health partnership in Georgia, see Addi- tional File 1). In this model, company-managed dispens- ing sites will serve company employees and family members; and, when dispensing is complete at company facilities, company employees will serve as volunteer staff Page 2 of 13 (page number not for citation purposes)