A framework for healthcare disaster resilience: a view to the future

This report analyzes a range of disasters that could confront the United States and consider their impacts on the healthcare system, including how medical care would be delivered in those scenarios, both to victims of the disaster and everyone else. This report finds that many of the current programs are quite valuable and should continue to be supported, and that several new initiatives should be pursued that would improve the disaster readiness and resilience of the US health sector.

Through a sequence of literature review, key informant interviews, focus groups, and a working group meeting, this report concludes that there are 4 categories of disasters that could cause significant illness and injury and for which the United States should be prepared. The importance of identifying these categories is that they pose different kinds of operational challenges, resource needs, and overall requirements. These categories are:

• Relatively small-scale mass injury/illness events: for example, bus crash, tornado, multiple shootings, local epidemics/small disease out breaks
• Large-scale natural disasters: for example, Hurricanes Maria, Sandy, Katrina; moderate earthquake; large-scale flooding, such as Hurricane Harvey
• Complex mass casualty events: for example, large-scale shootings (Las Vegas, Orlando) or bombings (Boston Marathon) with many victims, mass casualty burn events (Rhode Island nightclub), chemical or radio logical incidents, limited-scale bioterrorism, limited outbreaks of lethal and contagious infectious diseases, such as Ebola or SARS
• Catastrophic health events: for example, nuclear detonation, large-scale bioterrorism, severe pandemic, or major earthquake

A gap analysis for each type of disaster was conducted and concluded that the United States is fairly well prepared for relatively small-scale mass injury/illness events that happen more frequently, less well prepared for large-scale and complex disasters, and poorly prepared for catastrophic health events. To address these gaps, this report offers a series of recommendations.