Date:  March 21, 2012



IOM Report Provides Framework and Tools to Deliver Health Care Effectively During Catastrophic Disasters


WASHINGTON — While most areas of the country have systems in place to handle conventional disasters, such as a plane crash or building collapse, the infrastructure and systems to deliver health care during or following catastrophic situations, such as a widespread disease outbreak or a devastating earthquake, are rudimentary at best, says a new report from the Institute of Medicine.  The report provides a resource manual to guide health care organizations, public health agencies, first responder teams, and government agencies in delivering care as effectively as possible to the greatest number of people when such disasters occur.


The report recommends a systems-based approach to allocating resources and delivering care during crises.  It also provides tools and templates to help different stakeholders involved in disaster planning and response identify their core functions and responsibilities.  The report builds on earlier IOM study on developing and implementing crisis standards of care, which specify changes in operations that should apply in situations when usual medical capacity is overwhelmed and resources are scarce.


When catastrophic disasters occur, many stakeholders — hospitals and outpatient clinics, public health departments, the emergency medical system, public safety agencies, and government offices — play distinct, crucial roles.  A systems approach emphasizes the importance of coordination and integration across the full spectrum of these stakeholder groups to guarantee a unified, effective response, said the committee that wrote the report.  It ensures all stakeholders are following consistent protocols that take into account legal and ethical considerations when crisis standards of care take effect. 


Only a few communities currently have the level of integration necessary to provide oversight and care for an overwhelming number of victims, the committee noted.  All levels of government should take steps to ensure consistency and coordination of partners involved in emergency responses to disasters and should weave crisis standards of care into their surge capability planning and training exercises.  The U.S. departments of Health and Human Services, Homeland Security, Transportation, Defense, and Veterans Affairs should take measures to support this collaboration.


Implementation of crisis standards of care involves a substantial shift in normal health care activities and reallocation of staff, facilities, and resources.  To be ready to make the transition quickly and effectively, each organization and agency needs to identify in advance the core functions it must carry out in a crisis and who will be responsible for each task.  The report's templates are designed to help stakeholders define these responsibilities as part of developing their crisis plans.  The templates will also guide organizations in defining the criteria and process for shifting from conventional to crisis standards of care.


Because public engagement is crucial to the development and use of crisis standards of care, the report also provides a model process and set of tools that health authorities can use to hold public sessions on crisis planning and disaster response.  Such sessions will help the public understand why a shift in standards of care could become necessary and how these standards will be applied as well as changes in legal and regulatory authorities, the committee said.


"When a truly catastrophic event occurs, the nation's health system will be under enormous stress," noted committee chair Lawrence O. Gostin, associate dean and Linda D. and Timothy J. O'Neill Professor of Global Health Law, Georgetown University Law Center, Washington, D.C.  "Health professionals can bring the best care to the most people by using a systems approach that involves thoughtful coordination among all stakeholders and good planning and coordination among all levels of government.  This report provides an overarching framework for action in such events and provides detailed standards for each responsible group."


"Crisis standards of care planning and implementation will significantly increase the likelihood of saved lives and reduced suffering when catastrophic disasters occur," said vice chair Dan Hanfling, emergency physician and special adviser on emergency preparedness and disaster response, Inova Health System, Falls Church, Va., and clinical professor, department of emergency medicine, George Washington University, Washington, D.C.


The report was sponsored by the U.S. Department of Health and Human Services, U.S. Department of Transportation, and U.S. Department of Veterans Affairs.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The Institute of Medicine, National Academy of Sciences, National Academy of Engineering, and National Research Council together make up the independent, nonprofit National Academies.  For more information, visit or   A committee roster follows.


Additional Resources:

Report in Brief

Full Report

Project Website




Christine Stencel, Senior Media Relations Officer

Shaquanna Shields, Media Relations Assistant

Office of News and Public Information

202-334-2138; e-mail


Copies of Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at  Additional information is available at Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

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Board on the Health Sciences Policy


Committee on the Standards of Care for Use in Disaster Situations


Lawrence O. Gostin, J.D., LL.D. (chair)

Professor of Public Health

Johns Hopkins University;

University Professor and Linda and Timothy O’Neill Professor of Global Health Law;

The Linda and Timothy O'Neill Professor of Global Health Law

Georgetown University;

O'Neill Institute on National and Global Law; and


WHO Collaborating Center on Public Health Law and Human Rights

Georgetown University Law Center

Washington, D.C.


Dan Hanfling, M.D. (vice chair)

Special Advisor
Emergency Preparedness and Response
INOVA Health System

Falls Church, Va.


Damon T. Arnold, M.D., M.P.H.

Illinois Department of Public Health (retired)



Brooke Courtney, J.D., M.P.H.

Regulatory Counsel

Office of Counterterrorism and Emerging Threats U.S. Food and Drug Administration

Silver Spring, Md.


Stephen V. Cantrill, M.D., FACEP

Director of Emergency Medicine
Denver Health Medical Center



Asha Devereaux, M.D., M.P.H.

Pulmonary, Critical Care, and Internal Medicine

Coronado, Calif.


John L. Hick, M.D.

Associate Medical Director for Emergency Medical Services, and

Medical Director of Emergency Preparedness

Hennepin County Medical Center



James G. Hodge Jr., J.D., LL.M.

Lincoln Professor of Health Law and Ethics
Sandra Day O'Conner College of Law
Arizona State University



Donna E. Levin, J.D.

General Counsel
Massachusetts Department of Public Health



Marianne L. Matzo, Ph.D., A.P.R.N., G.N.P-B.C., F.P.C.N., F.A.A.N.

Professor and Frances E. and A. Earl Ziegler Chair in Palliative Care Nursing

University of Oklahoma

Oklahoma City


Cheryl A. Peterson, M.S.N., R.N.

Senior Policy Analyst
American Nurses Association

Silver Spring, Md.


Tia Powell, M.D.

Montefiore-Einstein Center
for Bioethics

Bronx, N.Y.


Merritt D. Schreiber, Ph.D.

Director of Psychological Programs

Center for Disaster Medical Sciences, and

Associate Clinical Professor of Emergency Medicine Irvine School of Medicine of Emergency Medicine

University of California



Umair A. Shah, M.D., M.P.H.

Deputy Director

Harris County Public Health and Environmental Services



Jolene R. Whitney, M.P.A.

Deputy Director
Emergency Medical Services and Preparedness
Utah Department of Health

Salt Lake City




Bruce Altevogt, Ph.D.

Study Director