issues or concerns about the use of exercises as a means to performance measurement.

At its fifth meeting, on March 29, 2004, the committee heard presentations about: CDC’s recent efforts in public health preparedness; the modeling workgroup of the Department of Health and Human Services (DHHS) Secretary’s Council on Public Health Preparedness; the theory and science related to preparedness and exercises1 from both a sociological and a disaster management and response perspective; the perspective of a Center for Public Health Preparedness; and the Department of Homeland Security’s experience with planning, conducting, and evaluating exercises. This letter report contains the committee’s findings and recommendations based on information from that meeting and additional though limited (given time constraints) review of what public health may learn from disaster research and from the practice of disaster response.


Charge to the Committee

One way to measure public health agencies’ performance in achieving preparedness is by performing and evaluating exercises.2 Whereas exercises have been conducted and evaluated in the emergency management field for many years, public health has had less experience with exercises and is currently beginning to assess their value for relationship building, training, and performance measurement. To place the role of exercises appropriately into the broader definition of what it means to be prepared and to identify specific aspects for which measures can be developed, CDC asked the Committee on Smallpox Vaccination Program Implementation to:

  1. Describe the state of the science in exercises and related preparedness strategies;

  2. Identify leadership and experience to build upon, from other fields and other federal agencies; and

  3. Identify issues or concerns about this approach to performance measurement (Sosin, 2004).


The Federal Emergency Management Agency (FEMA) defines exercise as “a focused practice activity that places the participants in a simulated situation requiring them to function in the capacity that would be expected of them in a real event” (FEMA/EMI, 2003).


Initially, the committee’s discussion was concerned with both exercises and drills, as they are related categories along a spectrum of possible activities used for training, performance measurement, etc. However, since drills tend to be very narrowly focused and they typically take place within a single agency, their usefulness is more easily verified. Therefore, they are less relevant to the present broad discussion of preparedness exercises and evidence of their usefulness.

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