standards of care (CSC) and ensure both an implementation plan and incorporation into the culture of the health spectrum.

Additional discussion about public health roles and responsibilities in planning for and implementing CSC is available in the Institute of Medicine’s (IOM’s) 2012 report Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. This report also includes planning and implementation templates that outline core functions and tasks.


Suggested participants for a discussion focused on public health are listed below. Building on the scenarios and overarching key questions presented in Chapter 3, this tool contains additional questions to help participants drill down on the key issues and details for public health. It also contains two charts (one for slow-onset and one for no-notice) that provide example public health indicators, triggers, and tactics, and a blank chart for participants to complete. The scenarios, questions, and example chart are intended to provoke discussion that will help participants fill in the blank chart for their own situation.1 Participants may choose to complete a single, general blank chart, or one each for various scenarios from their Hazard Vulnerability Analysis.

The questions below and associated table of sample indicators and triggers are broken out by the two scenarios because the role of public health will vary significantly based on the incident. Nearly all incidents or planned events will need public health and medical assistance and possible response. The first scenario demonstrates a slow-onset incident in which local and state public health would monitor the activity of influenza worldwide. This would provide an opportunity for planning and anticipating response activities. The second scenario demonstrates the issues associated with a no-notice event and describes potential points of consideration to respond and support response activities. In this scenario, there will be an immediate role of medical response, supported by public health, and intermediate- and long-term responsibilities for local and state public health offices.

Discussion Participants

From a public health perspective, any agency or organization that will be impacted in their service delivery by public health decisions should be discussion participants at some point in the deliberation process.2

Public health impacts all sectors and thus the need for integrated planning and long-term follow-up should be a key component in planning for and implementing CSC and will have a critical supporting role throughout an incident.

Local public health discussions should include their agency emergency management/preparedness coordinator, health officer, and medical director at a minimum. Agency subject matter experts (SMEs) should be engaged based on incident type, with consideration of potential clinical services impacted: communi-


1 The blank table for participants to complete can be downloaded from the project’s website:

2 As discussed above, the structure and organization of public health and health varies across states and localities. The discussion participants listed here are provided as a suggestion; discussion organizers should develop a participant list that would be appropriate for the structures and organization of the particular jurisdiction.

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