An influenza exercise in a major urban setting. II. Development of a health emergency operations center.

Strong relationships and partnerships must be developed for the mitigation of untoward secondary events and positive outcomes during large-scale disasters. Although a health-related emergency operations center-like structure within the Incident Command Structure is advantageous for every community, the process by which it is developed within a large urban setting will be a unique challenging task and requires unprecedented collaboration, cooperation, and coordination. This study explains the necessary components of a uniquely demanding development process leading to a health-related emergency operations center for Maricopa County, Arizona, the creation of which has significantly improved the effectiveness of multiagency involvement, communication, and decision making. Similar challenges will be faced by other urban settings.