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by Mark Keim, senior science advisor for the Office of the Director in the National Center for Environmental Health at the Centers for Disease Control and Prevention, focused on opportunities and challenges to integrate crisis standards of care principles into international disaster response plans.

The workshop used the IOM’s Crisis Standards of Care as a means to stimulate a discussion among international stakeholders. Expert panelists discussed:

  • The challenges of providing fair and equitable care in mass casualty incidents
  • A potential framework for the equitable delivery of care in situations of scarce resources, and strategies for operationalizing crisis standards of care in austere environments
  • Strategies for integrating crisis standards of care principles into disaster response plans
  • The impact of international disaster response on changing the standard of care in the “host” country

This report summarizes the presentations and commentary by the invited panelists.


In the United States, catastrophic disasters have been relatively infrequent events. For the purposes of this discussion, such events have been historically considered as those in which there are around 1,000 or more human casualties, explained Dan Hanfling, special advisor for Emergency Preparedness and Response at Inova Health System. Catastrophic disasters in the late 1800s and early 1900s were generally natural disasters (e.g., flash floods, forest fires) or transportation-related incidents (e.g., sinking steamships). Excluding the 1918 influenza pandemic and casualties of war, the U.S. health care system was not faced with catastrophic disasters for most for the 20th century. However, the terrorist attacks of 2001 and the devastation from Hurricane Katrina in the Gulf Coast in 2005 have


the WCDEM. This summary has been prepared by the rapporteurs as a factual overview of the presentations at the session. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the IOM or the Forum.

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