its investigation of the crash, the National Transportation Safety Board (NTSB) recommended that the Federal Interagency Committee on Emergency Medical Services (FICEMS), “evaluate the system of emergency care response to large-scale-transportation-related rural accidents and, once that evaluation is completed, develop guidelines for emergency medical service response and provide those guidelines to the states” (NTSB, 2009).

In response to a request from FICEMS, and with funding support from the National Highway Traffic Safety Administration (NHTSA), the Institute of Medicine (IOM) Forum on Medical and Public Health Preparedness for Catastrophic Events convened a workshop on August 3 and 4, 2010, to examine the current capabilities and future opportunities to improve integrated mass casualty response in rural settings.

Specifically the objectives of the workshop were to

  • Review the findings from the NTSB report of the 2008 Mexican Hat incident and discuss near- and long-term opportunities to improve response capabilities in rural settings.

  • Explore existing standards, guidance, and innovative models and approaches in place for state and local jurisdictions.

  • Examine integrated systems approaches to improve the capability of the emergency medical services (EMS) system to respond to large-scale rural incidents.

  • Discuss opportunities to improve integration and coordination with public health systems to address challenges to national public health security, particularly in rural settings.


The vast majority of the land mass in the United States is rural, and much of that is classified as “frontier,” which is defined as counties having less than six people per square mile.3 Mass casualty incidents (MCIs) in rural areas are not uncommon, said workshop chair Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems. A nationwide survey of rural hospital emergency departments conducted in 2006 found that more than one-third of those responding had been overwhelmed by what they classified as an MCI, at least once within the prior 2 years, and more than half reported activating their disaster plans within the prior 2 years (Manley et al., 2006). The hospitals cited a broad spectrum of incidents that led to activation of their disaster plans (see Box 1-1). While individual hospital systems are differentially affected by these events, the


Throughout this workshop summary, rural will be used to capture both rural and frontier settings.

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement