A public health preparedness exercise program can be a useful tool for developing, evaluating, and revising public health preparedness plans. A complete exercise program would include:

• Orientation exercises to identify policy issues raised by the emergency planning process
• Tabletop and functional exercises to test planning concepts, leading to improved procedures and organizational relationships
• Full-scale exercises to demonstrate competency

In 2001 the Oregon Department of Human Services Public Health Preparedness Program (OPHPP) initiated the first phase of a public health emergency exercise program, using the framework for emergency exercise design provided by the Federal Emergency Management Agency. The Department produced a Bioterrorism Preparedness Orientation Exercise and distributed it on CD-ROM to all local health department administrators. The transmittal letter that accompanied the exercise was dated September 10, 2001.

The purpose of the orientation exercise is to illustrate policy issues that may challenge existing local public health emergency plans. The exercise does not require a completed emergency plan and is intended to be conducted in a low-stress, collegial environment as a prelude to plan development or revision.

Oregon counties are required by law to have an emergency operations plan, including a health and medical annex. The quality of those plans, however, is not consistent throughout the state, and the orientation exercise is primarily intended to encourage local health districts to evaluate and revise their emergency plans. The CD-ROM includes public health emergency planning guidelines from the Centers for Disease Control and Prevention and other sources to help with the local planning process.

After local public health emergency plans have been developed or revised, in late summer 2002, OPHPP will distribute a bioterrorism "tabletop" exercise involving public health and other local public safety staffs, such as law enforcement, fire, public works, emergency management, and executive management.

As the OPHPP exercise program evolves, the department plans to develop "functional" exercises that focus on specific elements of public health preparedness. A functional exercise is a rigorous simulation conducted by specific elements of an emergency management organization. For example, simulation of dispensing prophylaxis treatment at an immunization clinic would be a functional exercise in the National Pharmaceutical Stockpile (NPS) planning process.

A full-scale exercise invites active participation by all elements of the jurisdiction's organization in field simulations, off-site coordination provided through an Emergency Operations Center, and leadership by executive management, including elected officials.

Such an exercise is intended to demonstrate that the previous orientation, tabletop, and functional exercises produced an effective emergency management plan and organization. It would also demonstrate to the community that the public health staff is prepared to respond to an emergency. One example of a full-scale exercise would be an NPS drill, in which the contents of an NPS 12-hour push-pack are received, staged, and distributed by state and local public health officials.

The exercise program will help state and local public health agencies in Oregon develop well-conceived emergency preparedness plans and ensure that emergency procedures are understood and practiced by all responders when a public health emergency strikes.

Michael McGuire is manager of the Public Health Preparedness Program and the Health Alert Network, in the Oregon Department of Human Services..

This article appears as a sidebar in Public Health Responds to the Spotlight on Bioterrorism