State and local officials who were interviewed at the sites visited in the course of the research (December 2001 - March 2002) reported varying levels of public health preparation for responding to outbreaks of emerging infectious diseases such as SARS. They identified gaps in preparedness that have been difficult to address, including the disease-surveillance and laboratory systems, as well as the response capacity of the workforce. State and local officials were also beginning to address gaps in preparedness in the area of communication; however, planning for regional coordination was lacking among States. Most hospitals reported training their staff to recognize the symptoms of infection from biological agents and in planning coordination with public health entities; however, hospitals still lack the capacity to respond to large-scale infectious disease outbreaks after they have been identified. Most emergency departments across the country have experienced some degree of overcrowding. Currently, there is no capability for hospital emergency departments to provide needed medical services to a high volume of victims of a bioterrorist event or a rapidly spreading infectious disease. Testimony before the House Subcommittee on Emergency Preparedness and Response, Select Committee on Homeland Security.