In 2009 the Institute of Medicine (IOM) began to assess the need for better-defined medical and public health crisis standards of care (CSC) for catastrophic disasters and public health emergencies. Over the next 10 years, the IOM defined templates for those stakeholders responsible for integrated CSC planning and implementation; created a tool kit with guidance on indicators and triggers; provided a discussion kit for stakeholders to use with their own communities to establish appropriate indicators and triggers to guide their planning; disseminated the messages and key concepts of CSC; and built on the initial efforts to refine certain elements and address remaining gaps. This current Proceedings of a Workshop captures the discussions from a 2019 workshop reviewing the successes and gaps over the last 10 years of CSC work, in order to inform the next phases of planning and implementation. Table of Contents Front Matter 1 Introduction 2 Informing the Next Stage of Crisis Standards of Care 3 Ethical and Legal Considerations 4 Crisis Standards of Care Application Across Sectors 5 Implementing Crisis Standards of Care Across Sectors References Appendix A: Workshop Agenda Appendix B: Speaker Biographies

Consequences of natural disasters and the COVID-19 pandemic have taken a cumulative toll on the health and well-being of people in the Gulf of Mexico region. Long-standing societal challenges related to racism, poverty, education, housing, and underemployment are compounding the trauma, leading to chronic stress for many Gulf residents. The Committee on Progress Toward Human Health and Community Resilience in the Gulf of Mexico Region new report, Advancing Health and Community Resilience in the Gulf of Mexico Region: A Roadmap for Progress, explores key challenges and priorities in Gulf states, including Alabama, Florida, Louisiana, Mississippi, and Texas and evaluates recent progress. The report also makes recommendations for closing critical gaps and implementing transformative approaches that focus on the diverse needs and experiences of people who live and work in the Gulf region. Table of Contents Front Matter Summary 1 Introduction 2 Understanding Systems of Health and Community Resilience 3 Addressing Critical Data Gaps in Human Health and Community Resilience in the Gulf Region 4 Strengthening the Foundation: Pillars for Progress Toward Health and Community Resilience in the Gulf Region 5 A Road Map for Advancing Progress Towards Health and Community Resilience in the Gulf Region Appendix A: References Appendix B: Public Session Agendas Appendix C: Commissioned Paper: Current State of Health, Community Resilience, and Cohesion in the Gulf of Mexico Region Appendix D: Committee Members and Staff Biographical Sketches

Crisis Standards of Care (CSC) inform decisions on medical care during a large-scale crisis such as a pandemic or natural disaster, eliminating the need to make these decisions at the bedside without protections or guidance. Numerous points throughout the COVID-19 pandemic have demonstrated the necessity of this type of crisis planning. The National Academies of Sciences, Engineering, and Medicine Forum on Medical and Public Health Preparedness for Disasters and Emergencies convened a series of public workshops to examine the experiences of healthcare providers during the COVID-19 pandemic and identify lessons that can inform current and future CSC planning and implementation. The workshops examined staffing and workforce needs, planning and implementation of CSC plans, and legal, ethical, and equity considerations of CSC planning. Topics of discussion included improving coordination between the bedside and boardroom, increasing buy-in from elected officials, expanding provider engagement, and addressing health equity issues. This publication summarizes the presentation and discussion of the workshops. Table of Contents Front Matter 1 Introduction 2 Reflections, Inflections, and the Future 3 Considerations for Staffing, Effects on the Workforce, and Future Trends 4 Crisis Standards of Care: From Plans to Reality 5 Legal, Ethical, and Equity Considerations for Crisis Standards of Care 6 Looking Forward References Appendix A: Workshop Agendas Appendix B: Speaker Biosketches

To explore issues related to the effects of disasters on children and youth and lessons learned from experiences during previous disasters, the virtual workshop From Hurricane Katrina to Paradise Wildfires, Exploring Themes in Disaster Human Services was convened on July 22 and 23, 2020, by the National Academies of Sciences, Engineering, and Medicine. The workshop was designed to focus on families engaged with federal, state or local supportive programs prior to disasters. Additional areas of focus were the coordination of disaster response efforts and the transition to reestablishing routine service delivery programs post-disaster by human services, social services, and public health agencies at the state, local, tribal, and territorial levels. The workshop was also intended to provide a platform for highlighting promising practices, ongoing challenges, and potential opportunities for coordinated delivery and restoration of social and human services programs. This publication summarizes the presentations and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Exposure Outliers: Children Coming of Age in an Age of Environmental Extremes 3 Effect of Disasters on Critical Child Infrastructure 4 Exploring the Gaps in Evidence 5 Case Studies: Effect of Disasters on Specific Populations 6 Workshop Reflections References Appendix A: Workshop Statement of Task Appendix B: Workshop Agenda Appendix C: Speaker Biographies

Large catastrophic events, or rare acute events, may cause situations in which a local jurisdiction's medicines and medical supplies are not sufficient to provide care to the population it serves. In these cases of natural or engineered disasters, such as a terrorist attack, influenza pandemic, or earthquake, state or local authorities can request that the federal government provide assets from the Strategic National Stockpile to augment the state and local jurisdictions' resources. The Centers for Disease Control and Prevention's (CDC's) Strategic National Stockpile (SNS) is the nation's repository of antibiotics, chemical antidotes, antitoxins, vaccines, antiviral drugs, and other medical materiel designed to supplement and resupply state and local public health agencies in the event of an emergency. The materiel is intended to support national health security and is managed by the Office of Public Health Preparedness and Response's (OPHPR's) Division of Strategic National Stockpile (DSNS). The stated mission of the SNS is to prepare and support partners and provide the right resources at the right time to secure the nation's health. The National Academies of Sciences, Engineering, and Medicine organized a two-day public workshop to explore opportunities to improve the efficiency, effectiveness, and sustainable methods used by the CDC's SNS to distribute medical countermeasures and other supplies during disasters and other public health emergencies, especially those which result in disruption of physical infrastructure such as the electrical grid, central roadways, bridges, and tunnels within the impacted community. Participants explored relevant distribution lessons learned from other federal agency stockpiles and the private sector as well as opportunities to develop public-private collaborations in the purchase, warehousing, management, and distribution of medical countermeasures. This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction, Background, and Context 2 The Strategic National Stockpile: Origin, Policy Foundations, and Federal Context 3 Studies and Reports Related to the Strategic National Stockpile 4 Potential Opportunities for Restructuring Strategic National Stockpile Scope, Governance, and Decision Making 5 Reaching the Last Mile: Potential Opportunities to Improve Coordination and Communication Among Local, State, and Federal Agencies 6 Potential Supply-Chain Opportunities and Lessons from the Commercial Sector and Government Partners 7 Wrap-Up References Appendix A: Workshop Agenda Appendix B: Workshop Speaker Biographies

The National Academies of Sciences, Engineering, and Medicine held a workshop on August 22?23, 2018, in Washington, DC, to explore medical and public health preparedness for a nuclear incident. The event brought together experts from government, nongovernmental organizations, academia, and the private sector to explore current assumptions behind the status of medical and public health preparedness for a nuclear incident, examine potential changes in these assumptions in light of increasing concerns about the use of nuclear warfare, and discuss challenges and opportunities for capacity building in the current threat environment. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Federal Planning for Nuclear Incidents 3 Current State of Nuclear Preparedness 4 Updating Planning Assumptions of Nuclear Preparedness 5 Implications of Communication, Education, and Information Challenges 6 Challenges for Building Capacity Within the Health Care System 7 Capability-Building Challenges and Opportunities: Building Response Capability 8 Capability-Building Challenges and Opportunities: Ensuring Workforce Readiness and Response Capacity 9 Building Preparedness and Response Capability: Looking to the Future 10 Reflections on the Workshop and Opportunities for Moving Forward References Appendix A: Workshop Agenda Appendix B: Workshop Speaker Biographies

COVID-19 has proven among the worst public health crises in a generation. Public health emergencies (PHE) have always been anticipated. Despite the growing field of PHE preparedness and planning since the turn of the twenty-first century and the preparedness plans and exercises developed, the U.S. experienced a suboptimal national response to the emergence of COVID-19 in early 2020 compared to other countries. To explore the U.S. PHE preparedness enterprise, the National Academies Forum on Medical and Public Health Preparedness for Disasters and Emergencies convened a workshop in May 2022. They invited participants from government, NGO, and private sector organizations to consider key components, success stories, and failure points in order to identify opportunities for more effective catastrophic disaster, pandemic, and other large scale PHEs planning at the federal, state, local, tribal, and territorial levels. This Proceedings of a Workshop summarizes the discussions held during the workshop. Table of Contents Front Matter 1 Introduction 2 Public Health Emergency Planning: Lessons from Past and Present for the Future 3 Coordinating Surveillance and Medical Countermeasure Response 4 Equity, Risk Communication, and Public Engagement 5 Coordination, Government, and Leadership 6 Reflections References Appendix A: Workshop Agenda Appendix B: Speaker and Planning Committee Biosketches