This case review describes the creation of a single incident management team by 5 independent local public health agencies to respond to the 2009 H1N1 influenza pandemic. It focuses at the policy level, describing relationship building between local public health agency leaders and the conditions required to support such a response. Readers will understand the precursors that allowed for this regionalized response, how the response was implemented, the lessons learned, and recommendations for future responses. As local health jurisdictions and tribes review and update their emergency response plans, they should consider forming a regionalized public health incident management team to conserve overhead resources and to ensure coordinated policies and public messaging for public health incidents that cross geopolitical boundaries.