Mass Medical Care with Scarce Resources: A Community Planning Guide

About This Guide

Purpose of the Guide

The purpose of this guide is to provide community planners—as well as planners at the facility/community, State, and Federal levels—with valuable information and insights that will help them in their efforts to plan for and respond to a mass casualty event (MCE). This guide provides information on:

This information will be useful in helping planners address the issues associated with preparing for and responding to an MCE in the context of broader emergency planning processes, such as those laid out in Standing Together: An Emergency Planning Guide for America's Communities, published by the Joint Commission on the Accreditation of Healthcare Organizations, 2005.

This document is intended not to reflect Department of Health and Human Services policy but to provide State and local planners with options to consider when planning their response to an MCE.

Development of the Guide

This guide builds and expands on an earlier document published by the Agency for Healthcare Research and Quality (AHRQ) that explored the issues and outlined the principles associated with the provision of medical care in the face of overwhelming numbers of casualties. It is the product of collaboration between the Office of the Assistant Secretary for Preparedness and Response (formerly the Office of Public Health Emergency Preparedness) and AHRQ, who coedited the guide.

Leading experts were identified and a series of papers was commissioned to address issues pertaining to six critical fields related to mass casualty care. Working individually or as parts of writing teams, the experts prepared drafts of their papers, which were presented for discussion among a broader group of experts at a meeting held in Washington, DC, on June 1-2, 2006. The writers incorporated much of the discussion and input from that meeting into their respective chapters.

The list of meeting participants, including lead authors and the members of the writing teams, is presented in Appendix A.


This planning guide is the product of a collaborative effort and as such reflects the extensive contributions of many knowledgeable individuals who shared their time, insights, experiences, and expertise. Their backgrounds and perspectives range from field experience in providing mass medical care with scarce resources to planning for such eventualities and all the related challenges.

We particularly would like to thank our expert teams who crafted critical content in specific areas.

In the area of prehospital care, our thanks go to Edward Gabriel, M.P.A., AEMT-P (Writing Team Lead); Peter Pons, M.D.; George Foltin, M.D.; Richard Serino, EMT-P; and Paul Maniscalco, M.P.A., EMT-P.

The writing team that addressed hospital and acute care issues was comprised of John L. Hick, M.D. (Writing Team Lead); Lewis Rubinson, M.D., Ph.D.; Daniel O'Laughlin, M.D.; Gabor Kelen, M.D.; Richard Waldhorn, M.D.; and Dennis P. Whalen.

The issues of alternative care sites were addressed by Stephen Cantrill, M.D. (Writing Team Lead); Dan Hanfling, M.D., FACEP; Peter Pons, M.D.; and Carl Bonnett, M.D.

An overview of the issues and challenges of providing palliative care was provided by Anne M. Wilkinson, M.S., Ph.D. (Writing Team Colead); Marianne Matzo, Ph.D., APRN, BC, FAAN (Writing Team Colead); Maria Gatto, M.A., APRN; and Joanne Lynn, M.D., M.A., M.S.

In addition, we would like to acknowledge the expert writings on ethical considerations provided by Marc Roberts, Ph.D., and Evan G. DeRenzo, Ph.D., and on the legal environment provided by James G. Hodge, Jr., J.D., LL.M.

This planning guide was prepared under contract with Health Systems Research, Inc. (HSR), an Altarum company. HSR staff members' contributions ranged from organizing and managing the input of all the expert teams and the planning, logistics, and facilitation of the expert meeting to the overall planning guide concept, design, and production. We would like to thank the HSR writing, editing, and production staff who were so instrumental in shaping this planning guide and ensuring that the final product would be of the greatest use for community planners in all settings: Lawrence Bartlett, Ph.D.; Valerie Gwinner, M.P.P., M.A.; Laurene Graig, M.A.; Dennis Zaenger, M.P.H.; Holly Doggett; Isha Fleming; Stephen Gilberg; Maureen Ball; Cheryl Bell; Katherine Flore, M.P.H.; and Laura Sternesky, M.P.A.

We sincerely hope that this community guide will serve as a practical tool for community planners across the United States as they consider the challenge of providing mass medical care with scarce resources.

Sally Phillips, R.N., Ph.D.
Director, Public Health Emergency Preparedness Research Program
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

Ann Knebel, R.N., D.N.Sc., FAAN
Captain, U.S. Public Health Service
Deputy Director for Preparedness Planning
Office of Assistant Secretary for Preparedness and Response
U.S. Department of Health and Human Services

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