The Emergency Preparedness Program of the Health Promotion Division took the lead and planned, coordinated, and facilitated the first ever, multi-regional, joint agency public health, hospital, and emergency management agency full-scale exercise on September 14-15, 2011, called Operation Rat Pack. This was a Homeland Security Exercise and Evaluation Program (HSEEP)-based exercise that involved 50 agencies from the Northeast and Northeast Central Ohio Homeland Security Planning Regions, along with the Ohio Department of Health. The objective of this full-scale exercise was to test the Cities Readiness Initiative and the Ohio Public Health Preparedness capabilities of public health incident management regarding mass prophylaxis planning, medical supplies management, epidemiology investigation and surveillance, emergency public information, environmental health response, and onsite incident management. As for specific major outcomes, MCHD tested, for the first time, its County Strategic National Stockpile (SNS) Distribution Site plan components, and was able to validate various areas of the plans as well as to view possible directions for plan improvements and future areas for training. As for staff involvement, there were approximately 20 MCHD staff members that served as players, to test the plans, but the execution and leadership originated from the two Emergency Preparedness Program staff. Mr. Justin Bechtel (Emergency Preparedness Planner and Safety Officer) served as the Overall Exercise Director, charged with scenario, inject, evaluation, and after-action development, along with overall exercise design and execution oversight for all playing agencies. As for the Medina County Health Department’s exercise execution lead, Ms. Jessica Miles (Emergency Preparedness Planner and Medical Reserve Corps Coordinator) served as the Lead Controller-Evaluator for the Medina County Health Department’s (MCHD) portion of the exercise. Her duty was to ensure proper exercise progress and evaluation, the days of the exercise. The three remaining Health Promotion staff served roles as one of the following positions at MCHD: exercise evaluator (Colleen Rice [emergency public information]), player (Kim Summers [Public Information Officer]), and observer (Kristen Hildreth). Overall, MCHD’s involvement was well executed, and this realistic scenario was an excellent way to practice and further preparedness efforts to deal with real-life public health incidents.