The purpose of the medical countermeasure operational readiness review (MCM ORR) is to assess, evaluate, and improve state and local operational readiness for a large medical countermeasure (MCM) response. Operational readiness is demonstrated through exercises or real world incidents. The MCM ORR allows for specificity on progress and gap elements that can be used to enhance a medical countermeasure response. Based on extensive input from subject matter experts and stakeholders, the Centers for Disease Control and Prevention (CDC) is implementing the Medical Countermeasure (MCM) risk-based planning approach, a revised risk criteria for state and local MCM risk planning and response. Public health departments throughout the nation will be required to prepare for response to a multiple planning scenarios including the intentional release of anthrax and emerging infectious diseases (EID).