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Two new reports from the U.S. Department of Health and Human Services' (HHS) Office of the Inspector General suggest that several states have failed to make appropriate medical surge preparations for a large-scale disaster, Modern Healthcare reports. The reports examined the preparedness of five states and 10 localities in late summer 2008, a full year before the World Health Organization announced the global H1N1 pandemic. Using data provided by the Assistant Secretary for Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC), the researchers determined that fewer than one-half of the selected localities had begun recruiting medical volunteers, with many of those localities reporting that they had concerns about using volunteers. In addition, no state included in the report had implemented an electronic system to register volunteers, despite an order by ASPR to implement such a system by August 2009. The report also found that, although all localities reported acquiring medical equipment for a pandemic, many reported difficulties managing what they deemed as limited caches of equipment. Among states that reported plans to use alternative care sites, such as schools or convention centers, none had plans in place regarding the scope of care or how such sites would be staffed, managed or supplied, and very few had signed a formal agreement with the alternative sites. Moreover, the report finds that most localities had no guidelines for altering triage, admission and patient care, and seven localities noted that local providers had expressed concern that they would be legally liable if they altered their standards of care. Finally, the report finds that all localities had conducted medical surge exercises, but most exercises were discussion-based rather than operations-based, and few localities consistently documented lessons learned. Meanwhile, a second report examined eight planning areas and 89 preparedness items for vaccines and antiviral drug distribution in the event of a pandemic. The report finds that none of the 10 localities had started planning for distribution or dispensing medication and, although the localities between September 2006 and July 2008 conducted 63 exercises toward this goal, most failed to create action reports or improvement plans following the exercises. Based on the data, the report authors recommend that the CDC work to determine the cause of any delays in preparedness and provide assistance accordingly. Moreover, the report authors conclude that the CDC should reiterate the importance of localities in crafting actionable vaccine and antiviral drug distribution and dispensing plans (Zigmond, Modern Healthcare, 9/21/09 [subscription required]; Clark, Health Leaders, 9/22/09).