Improving Water Emergency Preparedness through a Tabletop Exercise

Nov 06, 2019 | Guest Author

By Victoria O’Halloran, Former NACCHO Intern

Local health departments are at the forefront of preparing for and responding to public health emergencies. When these events occur, local health departments work alongside local and national partners to ensure the health and safety of their communities. Recent and more frequent complex emergencies and outbreaks associated with drinking water have highlighted the need for strong community partnerships, as well as coordinated operational response plans and processes between public health, emergency management, water utilities, and local government.

In the United States, approximately 42 billion gallons of water are consumed per day, delivered via one million miles of pipes across the country. Many of these pipes were laid in the early to mid‐20th century with a lifespan of 75 to 100 years. The quality of drinking water in the United States remains high, but due to America’s aging water infrastructure, between 14 to 18% of each day’s treated drinking water is lost due to leaking pipes. There are an estimated 240,000 water main breaks each year, resulting in loss of service and boil-water advisories.

Complex emergencies and outbreaks associated with drinking water trigger public health responses because of their potential for causing community-wide illness and disruption. If these events are not preceded by sufficient planning, training, and exercises, then the rapidity and efficiency of response by local authorities is compromised. Coordinated emergency response and risk communication between public health, water utilities, emergency management, and local governance is crucial for providing clear guidance on preventive measures and assuring the health of the population.

Recognizing the current gaps in water emergency preparedness and response, NACCHO, in collaboration with the CDC, conducted a small tabletop exercise (TTX) at the 2018 Preparedness Summit with conference participants and members of NACCHO’s Water, Sanitation and Hygiene (WASH) Emergency Preparedness Workgroup.

Building off the 2018 TTX, NACCHO, the Metropolitan Washington Council of Governments (MWCOG), and the Centers for Disease Control and Prevention (CDC) organized a TTX in Washington, DC on July 1, 2019 to promote collaboration across several agencies involved in responding to a water-related emergency. The exercise brought together a diverse group of representatives from local health departments, emergency management, water utility companies, and other community stakeholders to focus on preparing for high-impact water emergency response.

TTX Goals & Objectives

The goal of the July 2019 Regional Drinking Water TTX was to provide participants the opportunity to assess their preparedness and response protocols, plans, and capabilities for an emergency where a drinking water advisory is issued.


  1. Determine capabilities to deliver coordinated, prompt, reliable and actionable public information using appropriate communications channels.
  2. Ascertain the ability to establish and maintain a unified and coordinated operational structure and process integrating critical stakeholders.
  3. Consider the level of capability to provide life-sustaining services to the affected population.
  4. Assess the efficiency to provide decision-makers with decision-relevant information.
  5. Examine the ability to restore water service and address health concerns.
  6. Review lessons learned and identify improvements for the future.

Participants and Activities

Attendees congregated from Maryland, Virginia and Washington, DC to contribute their ideas at the TTX facilitated by Lisa Ragain at MWCOG. Seventy-two water-related professionals participated from local public health organizations, local and state emergency management teams, water utility companies, federal agencies and national associations.

Oscar Alleyne of NACCHO, Jonathan Yoder of the CDC, and Steve Bieber of MWCOG welcomed attendees to the drinking water advisory TTX, emphasizing the importance of protecting the health of our communities through water preparedness. They highlighted what a unique opportunity it was to collaborate in-person with a diverse group of water preparedness colleagues to close gaps in communication.

The TTX included four modules that played out a hypothetical drinking water emergency in detail. Participants were split into groups by state and advised to use the outlined scenario to answer follow-up questions after each module. These questions asked participants about ways to effectively act during the hypothetical scenario to best resolve the emergency. After the completion of all four modules in the separated groups, all attendees congregated into one hot wash discussion to debrief.

Lessons Learned

The facilitated hot wash discussion allowed attendees to learn how other jurisdictions planned to approach the same water emergency challenges. Best practices and alternate ways of resolving the drinking water TTX were addressed, in addition to a number of lessons learned.

Here are a few takeaways from the day:

  • Open communication between professionals with diverse experience and knowledge is crucial in preventing confusion in preparing for, responding to, and recovering from the loss of a city’s drinking water supply.
  • Developing strong partnerships and having tools to better respond to water emergencies can improve efficiency and help avoid error in response efforts.
  • Local health departments should be educated on key resources and tools at the community’s disposal before WASH emergencies to be ready to act.
  • Sharing and listening to other stakeholder roles in tabletop exercises allows community partners to see a situation from many perspectives. As a result, partners are able to make more informed decisions.
  • TTXs can be an easy and effective way of preparing any community for a water-related emergency. TTXs can be customized to meet specific community needs related to water preparedness and can be a useful tool for community stakeholders.

This WASH emergency exercise allowed participants to build capabilities that are useful and applicable in numerous jurisdictions. Bettering response coordination, critical decision-making and integration of resources are skills that translate to diverse populations and locations across the nation.

Learn more about NACCHO’s water work here. Contact Deise Galan at with any questions.

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About Guest Author

NACCHO periodically invites guest authors to write first-person accounts of their work in public health. To submit your own story for consideration, please visit our form.

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