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Post-Incident
Recovery Considerations
of the Health Care Service
Delivery Infrastructure
Workshop Summary
Theresa Wizemann and Bruce M. Altevogt,
Rapporteurs
Forum on Medical and Public Health Preparedness for
Catastrophic Events
Board on Health Sciences Policy
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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 Insti-
tute 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 contracts between the National Academy of Sciences and
the American College of Emergency Physicians; American Hospital Association; Ameri-
can Medical Association; American Nurses Association; Association of State and Territo-
rial Health Officials; Centers for Disease Control and Prevention (Contract No. 200-
2005-13434 TO #6); Department of the Army (Contract No. W81XWH-08-P-0934);
Department of Health and Human Services’ National Institutes of Health (Contract No.
N01-OD-4-2139 TO #198 and TO #244); Department of Health and Human Services’
Office of the Assistant Secretary for Preparedness and Response (Contract Nos.
HHSP233200900680P, HHS P23320042509X1); Department of Homeland Security’s
Federal Emergency Management Agency (Contract No. HSFEHQ-08-P-1800); Depart-
ment of Homeland Security’s Office of Health Affairs (Contract No. HSHQDC-07-C-
00097); Department of Transportation’s National Highway Traffic Safety Administration
(Contract No. DTNH22-10-H-00287); Department of Veterans Affairs (Contract No.
V101(93)P-2136 TO #10); Emergency Nurses Association; National Association of
Chain Drug Stores; National Association of County and City Health Officials; National
Association of Emergency Medical Technicians; Pharmaceutical Research and Manufac-
turers of America; Robert Wood Johnson Foundation; and United Health Foundation.
The views presented in this publication do not necessarily reflect the views of the organi-
zations or agencies that provided support for the project.
International Standard Book Number-13: 978-0-309-26060-2
International Standard Book Number-10: 0-309-26060-4
Additional copies of this report are available for sale 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:
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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 carving from ancient Greece, now held by
the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2012. Post-incident recovery considera-
tions of the health care service delivery infrastructure: Workshop summary. Washington,
DC: The National Academies Press.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating
society of distinguished scholars 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 gov-
ernment on scientific and technical 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 out-
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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 Sciences
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
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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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PLANNING COMMITTEE ON LONG-TERM RECOVERY OF
THE HEALTH CARE SERVICE DELIVERY
INFRASTRUCTURE1
JACK HERRMANN (Co-Chair), National Association of County and
City Health Officials, Washington, DC
LYNNE KIDDER (Co-Chair), Bipartisan WMD Terrorism Research
Center, Washington, DC
Project Staff
BRUCE M. ALTEVOGT, Preparedness Forum Director
KRISTIN VISWANATHAN, Research Associate (until June 2012)
ALEX REPACE, Senior Program Assistant
ANDREW M. POPE, Director, Board on Health Sciences Policy
1
Institute of Medicine planning committees are solely responsible for organizing the
workshop, identifying topics, and choosing speakers. The responsibility for the published
workshop summary rests with the workshop rapporteurs and the institution.
v
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FORUM ON MEDICAL AND PUBLIC HEALTH
PREPAREDNESS FOR CATASTROPHIC EVENTS1
ROBERT KADLEC (Co-Chair), PRTM Management Consultants,
Washington, DC
LYNNE KIDDER (Co-Chair), Bipartisan WMD Terrorism Research
Center, Washington, DC
ALEX ADAMS, National Association of Chain Drug Stores Foundation,
Alexandria, VA
GEORGES BENJAMIN, American Public Health Association,
Washington, DC
D. W. CHEN, Office of Assistant Secretary of Defense for Health
Affairs, Department of Defense, Washington, DC (since June 2012)
BROOKE COURTNEY, Food and Drug Administration,
Silver Spring, MD
JEFFREY DUCHIN, Seattle & King County and University of
Washington
ALEXANDER GARZA, Department of Homeland Security,
Washington, DC
JULIE GERBERDING, Merck Vaccines, West Point, PA
LEWIS GOLDFRANK, New York University Medical Center, NY
DAN HANFLING, Inova Health System, Falls Church, VA
JACK HERRMANN, National Association of County and City Health
Officials, Washington, DC
JAMES JAMES, American Medical Association, Chicago, IL
PAUL JARRIS, Association of State and Territorial Health Officials,
Arlington, VA
JERRY JOHNSTON, National Association of Emergency Medical
Technicians, Mt. Pleasant, IA (until January 2012)
BRIAN KAMOIE, The White House, Washington, DC
LISA KAPLOWITZ, Department of Health and Human Sciences
Office of the Assistant Secretary for Preparedness and Response,
Washington, DC
ALI KHAN, Centers for Disease Control and Prevention, Atlanta, GA
MICHAEL KURILLA, National Institute of Allergy and Infectious
Diseases, Bethesda, MD
JAYNE LUX, National Business Group on Health, Washington, DC
1
Institute of Medicine forums and roundtables do not issue, review, or approve
individual documents. The responsibility for the published workshop summary rests with
the workshop rapporteurs and the institution.
vii
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ANTHONY MACINTYRE, American College of Emergency
Physicians, Washington, DC
NICOLE MCKOIN, Target Corporation, Minneapolis, MN (from April
2012)
MARGARET MCMAHON, Emergency Nurses Association,
Williamstown, NJ
MATTHEW MINSON, Texas A&M University, College Station
ERIN MULLEN, Pharmaceutical Research and Manufacturers of
America, Washington, DC
CHERYL PETERSON, American Nurses Association,
Silver Spring, MD
STEVEN PHILLIPS, National Library of Medicine, Bethesda, MD
LEWIS RADONOVICH, Veterans Health Administration,
Washington, DC
JOSHUA RIFF, Target Corporation, Minneapolis, MN (until April
2012)
KENNETH SCHOR, Uniformed Services University of the Health
Sciences, Bethesda, MD (from April 2012)
ROSLYNE SCHULMAN, American Hospital Association,
Washington, DC
SARAH SEILER, Carolinas Medical Center, Charlotte, NC
RICHARD SERINO, Federal Emergency Management Agency,
Washington, DC
MICHAEL SKIDMORE, U.S. Department of Defense, Washington,
DC (until May 2012)
SHARON STANLEY, American Red Cross, Washington, DC
ERIC TONER, University of Pittsburgh Medical Center, PA
REED TUCKSON, UnitedHealth Group, Minneapolis, MN
MARGARET VANAMRINGE, The Joint Commission,
Washington, DC
GAMUNU WIEJETUNGE, National Highway Traffic Safety
Administration, Washington, DC
IOM Staff
BRUCE ALTEVOGT, Project Director
KRISTIN VISWANATHAN, Research Associate (until June 2012)
ALEX REPACE, Senior Program Assistant
ANDREW M. POPE, Director, Board on Health Sciences Policy
viii
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Reviewers
This workshop summary has been reviewed in draft form by individ-
uals chosen for their diverse perspectives and technical expertise, in ac-
cordance 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 summary as sound as possible and to ensure that the
summary meets institutional standards for objectivity, evidence, and re-
sponsiveness to the study charge. The review comments and draft manu-
script remain confidential to protect the integrity of the process. We wish
to thank the following individuals for their review of this summary:
James Craig, Mississippi State Department of Health
Onora Lien, King County Healthcare Coalition
Rev. Kevin Massey, Advocate Lutheran General Hospital
Linda Williams, Montana State University, Chouteau County
Extension
Although the reviewers listed above have provided many construc-
tive comments and suggestions, they did not see the final draft of the
workshop summary before its release. The review of this summary was
overseen by Kristine M. Gebbie, Flinders University School of Nursing
and Midwifery. Appointed by the Institute of Medicine, she was respon-
sible for making certain that an independent examination of this work-
shop summary was carried out in accordance with institutional
procedures and that all review comments were carefully considered. Re-
sponsibility for the final content of this summary rests entirely with the
workshop rapporteurs and the institution.
ix
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Contents
INTRODUCTION 1
THE FEDERAL GOVERNMENT: COORDINATOR AND
FACILITATOR 3
The National Disaster Recovery Framework, 3
Office of the Assistant Secretary for Preparedness and
Response—Portal to the Full Spectrum of Department of
Health and Human Services (HHS) Resources, 5
THE PRIVATE SECTOR: BUILDING RESILIENT
COMMUNITIES 7
Sharing Our Strengths, 7
The Power of Planning Together, 8
NONGOVERNMENTAL ORGANIZATIONS: PROVIDING
SUPPORT AND RELIEF 10
The American Red Cross, 10
LOCAL AND STATE ROLES: THE COMMUNITY AS THE
LEAD 12
Planning for the Unexpected, 13
Depth and Breadth of Local Recovery Planning and Priority
Setting, 14
BARRIERS AND CHALLENGES TO RECOVERY 15
FINAL REMARKS 17
xi
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xii CONTENTS
REFERENCE 17
APPENDIXES
A Workshop Statement of Task 19
B Agenda 21
C Speaker Biographies 23
