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Crisis Standards of Care A Systems Framework for Catastrophic Disaster Response Appendixes

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Crisis Standards of Care A Systems Framework for Catastrophic Disaster Response Volume 7: Appendixes Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations Board on Health Sciences Policy Dan Hanfling, Bruce M. Altevogt, Kristin Viswanathan, and Lawrence O. Gostin, Editors

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. HHSP23320042509XI between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Crisis standards of care : a systems framework for catastrophic disaster response / Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations, Board on Health Sciences Policy ; Dan Hanfling ... [et al.], editors. p. ; cm. Includes bibliographical references. ISBN 978-0-309-25346-8 (hardcover) — ISBN 978-0-309-25347-5 (pdf ) I. Hanfling, Dan. II. Institute of Medicine (U.S.). Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations. [DNLM: 1. Disaster Medicine—standards—United States. 2. Emergency Medical Services—standards—United States. 3. Emergency Treatment— standards—United States. WA 295] 363.34—dc23 2012016602 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carv- ing from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2012. Crisis Standards of Care: A Systems Framework for Cata- strophic Disaster Response. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished schol- ars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and techni- cal matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sci- ences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Acad- emy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON GUIDANCE FOR ESTABLISHING STANDARDS OF CARE FOR USE IN DISASTER SITUATIONS LAWRENCE O. GOSTIN (Chair), O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC DAN HANFLING (Vice-Chair), Inova Health System, Falls Church, VA DAMON T. ARNOLD, Illinois Department of Public Health, Chicago (retired) STEPHEN V. CANTRILL, Denver Health Medical Center, CO BROOKE COURTNEY, Food and Drug Administration, Bethesda, MD ASHA DEVEREAUX, California Thoracic Society, San Francisco, CA EDWARD J. GABRIEL,* The Walt Disney Company, Burbank, CA JOHN L. HICK, Hennepin County Medical Center, Minneapolis, MN JAMES G. HODGE, JR., Center for the Study of Law, Science, and Technology, Arizona State University, Tempe DONNA E. LEVIN, Massachusetts Department of Public Health, Boston MARIANNE MATZO, University of Oklahoma Health Sciences Center, Oklahoma City CHERYL A. PETERSON, American Nurses Association, Silver Spring, MD TIA POWELL, Montefiore-Einstein Center for Bioethics, Albert Einstein College of Medicine, New York, NY MERRITT SCHREIBER, University of California, Irvine, School of Medicine UMAIR A. SHAH, Harris County Public Health and Environmental Services, Houston, TX JOLENE R. WHITNEY, Bureau of Emergency Medical Services (EMS) and Preparedness, Utah Department of Health, Salt Lake City Study Staff BRUCE M. ALTEVOGT, Study Director ANDREW M. POPE, Director, Board on Health Sciences Policy CLARE STROUD, Program Officer LORA TAYLOR, Senior Project Assistant (until January 2012) ELIZABETH THOMAS, Senior Project Assistant (since February 2012) KRISTIN VISWANATHAN, Research Associate RONA BRIER, Editor BARBARA FAIN, Consultant for Public Engagement * Resigned from the committee October 2011. v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and techni- cal expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review com- ments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Richard Alcorta, Maryland Institute for Emergency Medical Services Systems Knox Andress, Louisiana Poison Center Connie Boatright-Royster, MESH Coalition Susan Cooper, Tennessee Department of Health Lance Gable, Wayne State University Center for Law and the Public’s Health Carol Jacobson, Ohio Hospital Association Amy Kaji, Harbor-UCLA Medical Center Jon Krohmer, Department of Homeland Security Onora Lien, King County Healthcare Coalition Suzet McKinney, The Tauri Group Peter Pons, Denver Health Medical Center Clifford Rees, University of New Mexico School of Law Linda Scott, Michigan Department of Community Health Robert Ursano, Uniformed Services University School of Medicine Lann Wilder, San Francisco General Hospital and Trauma Center Matthew Wynia, American Medical Association Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before vii

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its release. The review of this report was overseen by Dr. Georges Benjamin, American Public Health Asso- ciation. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. viii REVIEWERS

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Contents VOLUME 1: INTRODUCTION AND CSC FRAMEWORK Summary 1-1 1 Introduction 1-15 2 Catastrophic Disaster Response: Creating a Framework for Medical Care Delivery 1-31 3 Legal Issues in Emergencies 1-55 4 Cross-Cutting Themes: Ethics, Palliative Care, and Mental Health 1-71 VOLUME 2: STATE AND LOCAL GOVERNMENT 5 State and Local Governments 2-1 VOLUME 3: EMS 6 Prehospital Care: Emergency Medical Services (EMS) 3-1 VOLUME 4: HOSPITAL 7 Hospitals and Acute Care Facilities 4-1 VOLUME 5: ALTERNATE CARE SYSTEMS 8 Out-of-Hospital and Alternate Care Systems 5-1 VOLUME 6: PUBLIC ENGAGEMENT 9 Public Engagement 6-1 ix

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VOLUME 7: APPENDIXES A Glossary, 7-1 B Hospital Emergency Operations Plan Crisis Standard of Care Annex, 7-7 C Potentially Scarce Medical Resources by Category, 7-15 D Resource Challenges by Disaster Type, 7-17 E Statement of Task, 7-23 F Committee Biographies, 7-25 x CONTENTS

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E: Statement of Task Volume 7 In response to a request from the HHS Office of the Assistant Secretary for Preparedness and Response, the Institute of Medicine will convene an ad hoc committee to conduct a phase-two activity on standards of care for use in disaster situations. The committee will focus attention on developing guidance to establish standards of care that should apply to disaster situations—both naturally occurring and man-made—where there are scarce resources. Ethical principles will be incorporated into the standards. PHASE 2 In September 2009 the Institute of Medicine released Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. Building on this letter report the committee will reconvene to conduct a study and issue a report, which will serve as the second phase of this project. The committee is expected to come forward with conclusions and recommendations it determines are necessary and justified based on its analysis. Specifically the committee will • Identify metrics to assess the development of crisis standards of care protocols by state and local governments, that include elements such as dissemination, development, and implementation. • Review the impact of its 2009 letter report including progress made by state and local governments and health care organizations in establishing crisis standards of care guidance. • Develop templates for states, emergency medical services (EMS) systems, hospitals, and individual clinicians to guide decision making when implementing crisis standards of care that can be easily read, understood and executed during an incident. These templates will o Address the inclusion of all critical components of the emergency response and health care system necessary to plan for and respond to crisis standards of care situations. o Examine the specific process of declaring a shift to crisis standards of care, focusing on roles and responsibilities of decision makers from the local to the national level, including 7-23

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§ he roles and responsibilities of public and private health care systems (e.g., the responsibil- T ity of a local VA Medical Center Director vs. regional Veterans Integrated Service Network [ VISN] Director), authority and the role of military treatment facilities (MTFs), local, regional and national healthcare system clinical and administrative leadership in private health care systems; § he role of state EMS authorities in providing medical oversight and coordination of a shift T to crisis response for a state’s EMS system, including 911 dispatch and prehospital emergency medical care. o Identify clinical and administrative indicators that govern the transition from conventional surge response and conventional standards of care to crisis surge response and crisis standards of care, and the return to conventional standards of care. Reference and highlight existing clinical pro- tocols and related governance structures that need to be in place to facilitate decision making under crisis standards. These indicators, clinical protocols, and governance structures should be applicable to specific scenarios of both gradual onset as well as no notice incidents, and should pertain to the prehospital, community, and hospital settings. o Define terms and provide consistent language (e.g., definitions, situational markers) for com- municating across jurisdictions and levels of government the status of health care systems related to crisis standards of care. In addition the committee will develop templates that can be used by state and local governments to guide community engagement. These would be based on a series of focus groups utilizing scenario-based engagement strategies to identify what shifts are tolerable from the community point of view, including the physician, active duty military, and veteran’s communities. In order to accomplish this, the IOM may estab- lish a subcontract with an independent firm (e.g., Keystone Symposia, AmericaSpeaks, Harris Interactive) to assist in the design, organization, and execution of the meetings. The committee will provide the scientific and subject-matter expertise to the contractor to ensure the appropriate objectives are identified and met, e.g., the right questions are asked and the right populations are engaged in the process. 7-24 CRISIS STANDARDS OF CARE

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F: Committee Biographies Volume 7 Lawrence O. Gostin, J.D., LL.D. (Hon.) (Chair), is an internationally acclaimed scholar in law and public health. He is associate dean (Research and Academic Programs) and the Linda D. and Timothy J. O’Neill Professor of Global Health Law at the Georgetown University Law Center, where he directs the O’Neill Institute for National and Global Health Law. Dean Gostin is also a professor of Public Health at the Johns Hopkins University and director of the Center for Law & the Public’s Health at Johns Hopkins and Georgetown Universities—a Collaborating Center of the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). He is the health law and ethics editor, a contribut- ing writer, and a columnist for the Journal of the American Medical Association. In 2007, the WHO Director General appointed Dean Gostin to the International Health Regulations Roster of Experts and the Expert Advisory Panel on Mental Health. Dean Gostin is a member of the Institute of Medicine (IOM)/National Academy of Sciences, and serves on the Board on Health Sciences Policy and the Committee on Science, Technology, and Law. He has previously chaired committees on health information privacy, genomics, and prisoner research. In the United Kingdom, he was the legal director of the National Association for Mental Health, director of the National Council of Civil Liberties (the U.K. equivalent of the American Civil Lib- erties Union), and a Fellow at Oxford University. He helped draft the current Mental Health Act (England and Wales) and brought several landmark cases before the European Commission and Court of Human Rights. Dean Gostin has led major U.S. law reform initiatives, including the drafting of the Model Emergency Health Powers Act to combat bioterrorism and the Turning Point Model State Public Health Act. He is also leading a drafting team on developing a Model Public Health Law for WHO. Dan Hanfling, M.D. (Vice Chair), is special advisor to the Inova Health System in Falls Church, VA, on matters related to emergency preparedness and disaster response. He is a board-certified emergency physi- cian practicing at Inova Fairfax Hospital, Northern Virginia’s Level I trauma center. He serves as an opera- tional medical director for PHI Air Medical Group—Virginia, and has responsibilities as a medical team manager for Virginia Task Force One, an international urban search and rescue team sanctioned by FEMA and USAID. He has been involved in the response to numerous international and domestic disaster events. Dr. Hanfling was integrally involved in the management of the response to the anthrax bioterror mailings, when two cases of inhalational anthrax were successfully diagnosed at Inova Fairfax Hospital. He is clinical professor of Emergency Medicine at George Washington University, contributing scholar at the UPMC 7-25

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Center for Biosecurity, and adjunct faculty of the George Mason University School of Public Policy, Office of International Medical Policy. Dr. Hanfling received an A.B. in Political Science from Duke University and an M.D. from Brown University. He completed an internship in Internal Medicine at the Miriam Hospital in Providence, RI, and an Emergency Medicine Residency at George Washington/Georgetown University Hospitals. Damon T. Arnold, M.D., M.P.H., currently serves as the director for Graduate Studies in Public Health at Chicago State University in Illinois. He was the 16th director of the Illinois Department of Public Health from 2007 to 2011. Prior to his current position, Dr. Arnold was the medical director for bioterrorism and preparedness for the Chicago Department of Public Health. During his professional career, he also was medical director for St. Francis Hospital, Blue Island, IL; LTV Steel Company in Indiana; and Mercy Hos- pital and Medical Center, Chicago. He served in the Army National Guard for 25 years, holds the rank of colonel, and was the guard’s commander of the Joint Task Force Medical Command in Springfield and the Illinois State Surgeon. He had a distinguished military career and received many military awards, including the Legion of Merit, three Army Commendations, and two National Defense Service and Humanitarian Service medals. He has served missions to Iraq, Kuwait, Central America, South America, Africa, and Europe, and participated in relief efforts for Hurricanes Katrina and Rita. He was the American Red Cross Military Hero of the Year for 2007. Dr. Arnold is the former chair of the Association of State and Territorial Health Officials (ASTHO) Preparedness Policy Committee, served as a board member for the American Red Cross of Greater Chicago, and served as the ASTHO Liaison Representative for the CDC Board of Scientific Counselors, Coordinating Office for Terrorism Preparedness and Emergency Response. Dr. Arnold also holds associate professorships at the University of Illinois School of Public Health, the Univer- sity of Illinois Medical School, and the Southern Illinois Medical School. Dr. Arnold received his M.D. and M.P.H. from the University of Illinois, and has completed several law courses at DePaul University College of Law. Stephen V. Cantrill, M.D., FACEP, is an emergency physician from Denver who recently retired from serving as the associate director of Emergency Medicine at Denver Health Medical Center for 18 years. He was also the director of the Colorado BNICE Weapons of Mass Destruction (WMD) Training Program at Denver Health for more than 5 years. Dr. Cantrill has lectured nationally and internationally on many topics, including weapons of mass destruction, disasters, and disaster management, and has been involved in disaster management education for more than two decades. He served as the regional medical coordina- tor for Denver’s participation in Operation TopOff 2000. He has also been involved in weapons of mass destruction training for Colorado and has participated in the planning for multiple mass-gathering events, including the Denver Papal visit and the Denver Summit of Eight world economic conference. He has testified at U.S. Senate Committee hearings on bioterrorism preparedness and was a member of the U.S. Department of Health and Human Services (HHS) National Biodefense Science Board for 4 years. He has recently served as the Principal Investigator on an Agency for Healthcare Research and Quality (AHRQ) regional surge capacity grant and the AHRQ HAvBED national bed availability project. He also served as Principal Investigator on the AHRQ disaster alternate care facility task order. Dr. Cantrill has authored more than 90 publications and has received multiple teaching and clinical excellence awards. 7-26 CRISIS STANDARDS OF CARE

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Brooke Courtney, J.D., M.P.H., is regulatory counsel in the Food and Drug Administration’s (FDA’s) Office of Counterterrorism and Emerging Threats. Ms. Courtney was previously director of the Office of Public Health Preparedness and Response at the Baltimore City Health Department, where she oversaw all emergency operations for the agency, coordinated the city’s healthcare coalition, and oversaw medical countermeasure (MCM) stockpiling and dispensing. She was an associate at the Center for Biosecurity, where she researched and published on hospital, public health, and legal preparedness issues and was associ- ate editor of the peer-reviewed journal, Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. Ms. Courtney has also worked at Pfizer, at the Maryland Health Care Commission, and on international disaster response at the American Red Cross. She is a term member of the Council on Foreign Relations, the 2010 recipient of the Public Health Law Association’s Emerging Leader in Public Health Law award, and lead author of the MCM chapter in Food and Drug Law and Regulation. She received her J.D. and Health Law Certificate from the University of Maryland Carey School of Law and was admitted to practice in the District of Columbia and Maryland. Her M.P.H. is from Yale University. Asha Devereaux, M.D., M.P.H., is a pulmonary/critical care physician in private practice in Coronado, CA. Dr. Devereaux has 11 years of training and service with the U.S. Navy and formerly served as the Inten- sive Care Unit (ICU) director on the Isolation Unit of the USNS Mercy Hospital ship. She is currently a Steering Committee Member for the American College of Chest Physicians Disaster Response Network. Dr. Devereaux has spearheaded a national conference on disaster preparedness, has published on the topic, and now serves on the board of the American Lung Association in California and on the Board of Direc- tors of the San Diego American Lung Association. Dr. Devereaux is president of the California Thoracic Society and lead physician advisor of the San Diego Medical Reserve Corps. Dr. Devereaux received her undergraduate education at the University of California, San Diego, followed by an M.D./M.P.H. from Tulane University. Edward J. Gabriel, M.P.A., AEMT-P,1 is director, Global Crisis Management, for The Walt Disney Com- pany, and is responsible for the development and implementation of global policy, planning, training, and exercises to manage crisis for The Walt Disney Company. He is also responsible for East and West Coast Medical and Emergency Medical Operations and the Walt Disney Studio’s Fire Department. He supports and collaborates with global business units in development and testing of resumption planning, and develops policies and strategies to manage crisis. Mr. Gabriel has been an emergency medical technician (EMT) since 1973 and is a 27-year paramedic veteran of New York City (NYC) Fire Department’s Emergency Medi- cal Service (EMS). He rose through the ranks from EMT to paramedic through lieutenant and retired at the level of assistant chief/division commander. As deputy commissioner for Planning and Preparedness at the New York City Office of Emergency Management, he served as commissioner for all preparedness and planning-related projects and initiatives. During his role with NYC, he was a member of the Federal Bureau of Investigation/NYC Joint Terrorism Task Force, and still sits on the International Advisory Board of the Journal of Emergency Care, Rescue and Transportation. He has worked with the Joint Commission, sitting on the Emergency Preparedness Roundtable as well as the Community Linkages in Bioterrorism Preparedness 1 Resigned from the committee October 2011. APPENDIX F 7-27

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Expert Panel. He served as a member of the HHS Federal Contingency Medical Facility Working Group and the AHRQ Expert Panel on Mass Casualty Medical Care. Most recently he has worked with the HHS AHRQ expert panel as Principal Author of the prehospital chapter of Providing Mass Medical Care with Scarce Resource: Community Planning Guide. He also worked with the U.S. Department of Defense, General George C. Marshall School of International Studies Program on Terrorism and Security Studies, located in Garmisch-Partenkirchen, Germany, presenting on methodologies for planning and preparedness for international leaders. He is credentialed through the International Association of Emergency Manag- ers as a Certified Emergency Manager and the Disaster Recovery Institute International as a Certified Business Continuity Professional. Mr. Gabriel continues to lecture nationally and internationally on crisis management, business continuity, emergency management, planning and preparedness, WMD, terrorism, and emergency medical topics. Mr. Gabriel holds a B.A. from the College of New Rochelle and an M.P.A. from Rutgers University. John L. Hick, M.D., is a faculty emergency physician at Hennepin County Medical Center (HCMC) and an associate professor of Emergency Medicine at the University of Minnesota. He serves as the associ- ate medical director for Hennepin County Emergency Medical Services and medical director for Emer- gency Preparedness at HCMC. He is medical advisor to the Minneapolis/St. Paul Metropolitan Medical Response System. He also serves the Minnesota Department of Health as the medical director for the Office of Emergency Preparedness and medical director for Hospital Bioterrorism Preparedness. He is the founder and past chair of the Minneapolis/St. Paul Metropolitan Hospital Compact, a 29-hospital mutual aid and planning group active since 2002. He is involved at many levels of planning for surge capacity and adjusted standards of care. He traveled to Greece to assist in health care system preparations for the 2004 Summer Olympics as part of a 15-member CDC/HHS team. He is a national speaker on hospital preparedness issues and has published numerous papers dealing with hospital preparedness for contaminated casualties, personal protective equipment, and surge capacity. James G. Hodge, Jr., J.D., LL.M., is the Lincoln Professor of Health Law and Ethics at the Sandra Day O’Connor College of Law; director, Public Health Law and Policy Program; and Fellow, Center for the Study of Law, Science, and Technology, at Arizona State University (ASU). He is also a senior scholar at the Centers for Law and the Public’s Health: A Collaborative at Johns Hopkins and Georgetown Univer- sities, and the director of the Western Region Office of the Network for Public Health Law and current president of the Public Health Law Association. Prior to joining ASU, he was a professor at the Johns Hop- kins Bloomberg School of Public Health; adjunct professor of Law at Georgetown University Law Center; executive director of the Centers for Law and the Public’s Health; and a Core Faculty member of the Johns Hopkins Berman Institute of Bioethics. Through his scholarly and applied work, Professor Hodge delves into multiple areas of public health law, global health law, ethics, and human rights. The recipient of the 2006 Henrik L. Blum Award for Excellence in Health Policy from the American Public Health Association (APHA), he has drafted (with others) several public health law reform initiatives, including the Model State Public Health Information Privacy Act, the Model State Emergency Health Powers Act, the Turning Point Model State Public Health Act (Turning Point Act), and the Uniform Emergency Volunteer Health Practitioners Act. His diverse, funded projects include work on (1) the legal framework underlying the use of volunteer health 7-28 CRISIS STANDARDS OF CARE

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professionals during emergencies; (2) the compilation, study, and analysis of state genetics laws and poli- cies as part of a multiyear project funded by the National Institutes of Health; (3) historical and legal bases underlying school vaccination programs; (4) international tobacco policy for WHO’s Tobacco Free Initia- tive; (5) legal and ethical distinctions between public health practice and research; (6) legal underpinnings of partner notification and expedited partner therapies; and (7) public health law case studies in multiple states. He is a national expert on public health information privacy law and ethics, having consulted with HHS, CDC, FDA, CMS, OHRP, APHA, CSTE, APHL, and others on these privacy issues. Donna E. Levin, J.D., M.A., is general counsel for the Massachusetts Department of Public Health. Prior to her 1988 appointment, She served as a deputy general counsel and concentrated on several areas of health law, including determination of need, long-term care and hospital regulation, and environmental health. In her current role, she manages the Office of General Counsel and advises the Commissioner of Public Health and senior staff on all legal aspects concerning the implementation of Department responsibilities pursuant to statutory and regulatory authority; major policy initiatives of the Department; and legislation affecting the Department’s interests. Most recently, Ms. Levin has focused on the expansion of newborn screening services in the Commonwealth; the review and analysis of the Massachusetts Law on Genetics and Privacy; implementation of the Health Insurance Consumer Protections Law and the Pharmaceutical and Medical Device Manufacturer Conduct Law; issues of public health authority and response relating to emergency prepared- ness; and legal oversight of nine Boards of Registration for health professionals. Ms. Levin is a member of the Health Law Section Steering Committee of the Boston Bar Association and an adjunct professor at Suffolk University Law School. She holds a B.A. from the State University of New York at Stony Brook and a J.D. from Northeastern University School of Law. Marianne Matzo, Ph.D., APRN, BC, FPCN, FAAN, is professor and Ziegler Endowed Chair in Palliative Care Nursing at the College of Nursing and adjunct professor, Department of Geriatric Medicine, at the University of Oklahoma Health Sciences Center. Dr. Matzo is director of the Sooner Palliative Care Insti- tute, through which research is conducted to ensure the delivery of high-quality care and to educate health professionals. She has received research funding from the American Cancer Society and the Oncology Nurs- ing Society to conduct research related to sexual health issues in the palliative care population. She was a 2008 Recipient of the Project on Death in America Nursing Leadership Award in Palliative Care sponsored by the Hospice and Palliative Nurses Foundation. Dr. Matzo is a nationally and internationally recognized palliative care educator having developed and taught educational programs in Japan, Russia, and Serbia. In addition, Dr. Matzo is a three-time winner of the American Journal of Nursing Book of the Year award. Dr. Matzo had published in numerous peer-reviewed publications and is involved in ongoing work in disaster planning for situations in which there are scarce resources. Cheryl A. Peterson, M.S.N., R.N., is the director of Nursing Practice and Policy at the American Nurses Association (ANA). Prior to that, she was a senior policy fellow for the ANA, responsible for researching and developing association policy related to preparing for and responding to a disaster, whether man-made or natural. Since 1998, Ms. Peterson has been actively involved in disaster planning at the federal level. In addition, she coordinated ANA’s response to the Tsunami disaster in Southeast Asia and to hurricanes dur- APPENDIX F 7-29

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ing the 2005 U.S. hurricane season. Ms. Peterson spent 13 years in the Reserve Army Nurse Corps and in 1990, was deployed during Desert Storm. She also spent 7 years as an active volunteer in the Kensington Volunteer Fire Department (Montgomery County, Maryland). Ms. Peterson received her B.S.N. from the University of Cincinnati and her M.S.N. from Georgetown University. Tia Powell, M.D., is director of the Montefiore-Einstein Center for Bioethics and of the Einstein-Cardozo Master of Science in Bioethics, and professor of Clinical Epidemiology and Clinical Psychiatry at Albert Einstein College of Medicine. Previously she served as executive director of the New York State (NYS) Task Force on Life and the Law. She was the founding director of Clinical Ethics at Columbia-Presbyterian Hos- pital in New York City, where she launched the bioethics consultation service. She is a graduate of Radcliffe College of Harvard University, and Yale Medical School. She did her psychiatric internship, residency, and a Fellowship in Consultation-Liaison Psychiatry all at Columbia University, College of P&S, and the NYS Psychiatric Institute. In 2007, she chaired a workgroup that developed NYS guidelines to allocate ventilators during a flu pandemic. She has served as an advisor on the ethics of disasters for a number of committees sponsored by IOM, CDC, and others. Merritt Schreiber, Ph.D., is the director of Psychological Programs at the Center for Disaster Medical Sciences, and an associate clinical professor of Emergency Medicine at the University of California, Irvine School of Medicine. Previously, Dr. Schreiber was an associate research psychologist in the Department of Community Health Sciences in the University of California, Los Angeles (UCLA) School of Public Health. He was appointed to the HHS Secretary’s Emergency Public Information and Communications Advisory Board, where he helped draft several policy recommendations on the risk communications for our nation and particularly the needs of children and families. Dr. Schreiber was the program manager of the Terrorism/Disaster Branch of the UCLA/National Center for Child Traumatic Stress at the David Geffen School of Medicine at UCLA. He coordinated the NCCTS/TDB Rapid Response Support Team of National Child Traumatic Stress Network for disasters, terrorism, and mass casualty events impacting children and families. He also served as cochair of the Pediatric Emergency Mental Health Taskforce as the American Psychological Association to the HHS/Emergency Medical Services for Children Program. He received a presidential citation from the American Psychological Association for his work with victims’ families after 9/11 and received the Outstanding Humanitarian Contribution Award from the California Psychological Association in 2004. Dr. Schreiber was a first responder to Hurricane Katrina as a reserved commissioned officer with the U.S. Public Health Service and as mental health team lead with California Disaster Medical Assistance Team CA-1 of the U.S. Department of Homeland Security’s National Disaster Medical System. Dr. Schreiber also developed the first known disaster behavioral health rapid triage and incident management system, called PsySTART. Umair A. Shah, M.D., M.P.H., has served as deputy director and director of Disease Control & Clinical Prevention at Harris County, TX Public Health & Environmental Services (HCPHES)—the county health department serving the third most populous county in the United States—since 2004. Prior to HCPHES, Dr. Shah was an emergency department physician at Houston’s Michael E. DeBakey VA Medical Center 7-30 CRISIS STANDARDS OF CARE

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(MEDVAMC), then chief medical officer at the Galveston County Health District. Dr. Shah’s interests include global and refugee health issues; health equity work; health care management; emergency response activities for events such as Tropical Storm Allison and Hurricanes Katrina, Rita, and Ike; novel H1N1; and the devastating earthquakes in Kashmir and Haiti. His global experience also includes previous work at WHO in Geneva. He is involved in numerous national initiatives, including the APHA Injury Control & Emergency Health Services; the National Association of County and City Health Officials’ (NACCHO’s) National Coalition for Health Equity; UCLA’s Preparedness and Emergency Response Research Center Advisory Board; the National Consensus Panel on Emergency Preparedness and Cultural Diversity (spon- sored by the HHS); and various activities related to the CDC. Dr. Shah is immediate past chair of the South Asian Public Health Association, currently chairs NACCHO’s Global Health Workgroup, and was recently selected to the prestigious National Public Health Leadership Institute. In addition to national recognition, Dr. Shah is also involved in the local community, serving in leadership roles with Developments in Literacy, the South Asian Chamber of Commerce, and the Harris County Medical Society. He is an adjunct faculty member at The University of Texas School of Public Health and remains on emergency department staff at the MEDVAMC. He is board certified in Internal Medicine, remains active in clinical patient care, and serves as one of the local health authorities for Harris County. Dr. Shah received a B.A. in Philosophy from Vanderbilt University and an M.D. from The University of Toledo Health Science Center, before complet- ing a residency in Internal Medicine, Fellowship in Primary Care/General Medicine, and an M.P.H. (man- agement) at The University of Texas Health Science Center at Houston. Jolene R. Whitney, M.P.A., is currently the deputy director for the Utah Bureau of Emergency Medical Services and Preparedness, and also serves as the state trauma system program manager. She directs several programs and staff performing various functions related to Trauma System Development (including Stroke and STEMI Chemical Stockpile Emergency Preparedness, Surge Capacity and MCI Planning, ED, Trauma and Prehospital databases, EMS Licensing and Operations, certification and testing processes, Critical Inci- dent Stress Management, National Disaster Medical System, EMS medical disaster resources, and the EMS for Children program. She has worked with the Bureau for more than 30 years. Ms. Whitney earned her M.P.A. from Brigham Young University and her B.S. in Health Sciences, with an emphasis in Community Health Education, from the University of Utah. Ms. Whitney is coauthor of five publications pertaining to domestic violence, preventable trauma mortality in Utah, Western states rural care challenges, and state and hospital surge capacity planning. Ms. Whitney has served on several national committees and teams, which include state EMS system assessments for the National Highway Traffic and Safety Administration (NHTSA) (Michigan, Delaware, Oklahoma, Ohio and Missouri), American College of Surgeons trauma system assessments (Alaska, Arkansas, Colorado, Louisiana, Minnesota, and Texas); Health Resources and Services Administration (HRSA) rural trauma grant reviewer; and contributor to the development of the HRSA model trauma system plan, the National Association of State Emergency Medical Services Officials trauma system planning guide, National Trauma Data Standards, and the NHTSA curriculum for an EMT refresher course. She is the previous past chair for the National Council of State Trauma System Managers/ NASEMSO and served as vice chair for the previous 3 years. She is a member of the American Trauma Society and Utah Emergency Managers Association, and a previous member of the National Association of APPENDIX F 7-31

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State EMS Training Coordinators and the Utah Public Health Association. Ms. Whitney spent 250 hours in the Olympic Command Center, serving as the hospital liaison for the 2002 Winter Olympics in Salt Lake City. Ms. Whitney is currently assisting with the development of UT DMAT-1, has recently been hired as a federal intermittent employee for the team, and serves as the acting Planning Section Chief. She was certi- fied as an EMT in 1979 and became certified as an intermediate EMT in 1983. 7-32 CRISIS STANDARDS OF CARE