A nationwide survey of State and local response organizations was conducted just prior to the September 11 terrorist attacks. Respondents were asked a series of questions regarding their organizations’ preparedness for emergency response, and given a series of scenarios addressing hypothetical threats to assess their organizations’ level of ability to respond to such incidents. One tool for ensuring an effective response is whether public health departments and general acute care private and public hospitals at the local level have mutual aid agreements that address sharing of resources and personnel in the event of a WMD-related incident. Results of the survey show that two-thirds of local public health departments and 85 percent of hospitals have informal or formal mutual aid agreements with other city, county, State, or regional organizations for disasters and emergency response in general. Only 1 out of 10 local health departments and hospitals have mutual aid agreements that specifically address incidents involving WMD. Only about one-third of local public health departments and hospitals reported having plans or standard operating procedures (SOPs) in place for response to a moderate-sized biological scenario. Public health departments and hospitals in large metropolitan counties were only somewhat more likely than other counties to have such response plans. The preparedness of the public health system for chemical incidents is similar to that for biological incidents. Response plans for a chemical incident were more likely to have been exercised within the past year than response plans for a biological incident. Overall, large metropolitan counties with a population of one million or more appear to be better prepared for biological or chemical terrorism than other counties. 27 endnotes