Planning considerations for persons with access and functional needs in a disaster—Part 3: Medical CMIST and recommendations


  • Sharon E. Mace, MD
  • Constance J. Doyle, MD
  • Kim Askew, MD
  • Stuart Bradin, DO
  • Mark Baker, MD
  • Madeline M. Joseph, MD
  • Annalise Sorrentino, MD



disasters, at-risk populations, special healthcare needs, vulnerable populations


Although disasters can affect anyone in a given community or region, those with access and functional needs have the highest rates of morbidity and mortality during an emergency or disaster. There are many unique and complex issues that should be considered when dealing with these individuals in a disaster situation. Who are these individuals, what specific issues should be addressed when considering these members of the population, and what recommendations can be made in order to address their unique needs? How can we include them as part of the all-hazard, comprehensive approach to disaster management? The first part of this three-part series identifies who is included in this population and what are the legal considerations that arise in caring for not only this unique group but also all of the members of the community in a disaster. The second part considers evacuation, sheltering, sheltering in place, communication, medical needs, independence, supervision, and transportation (CMIST) with a focus on mental health. The third part deals with the medical aspect of CMIST and with recommendations that may aid disaster responders and planners in caring for these high-risk individuals in a disaster.

Author Biographies

Sharon E. Mace, MD

Professor of Medicine, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio; Director of Research and Associate EMS Medical Director, Department of Emergency Medicine, Cleveland Clinic Health System, Cleveland, Ohio; Faculty MetroHealth Medical Center/Cleveland Clinic Emergency Medicine Residency, Cleveland, Ohio

Constance J. Doyle, MD

Emeritus Attending Physician, Department of Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan; Retired Clinical Instructor, University of Michigan/ St. Joseph Emergency Medicine Residency, Ann Arbor, Michigan; Retired Medical Officer, Michigan 1 - DMAT, Ann Arbor, Michigan

Kim Askew, MD

Assistant Professor, Department of Emergency Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina

Stuart Bradin, DO

Associate Professor of Pediatrics and Emergency Medicine, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, The University of Michigan Health System, Ann Arbor, Michigan

Mark Baker, MD

Associate Professor, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Alabama, Birmingham, Alabama

Madeline M. Joseph, MD

Professor of Emergency Medicine and Pediatrics, Assistant Chair of Pediatric Emergency Medicine Quality Improvement, Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida

Annalise Sorrentino, MD

Professor of Emergency Medicine, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Alabama, Birmingham, Alabama


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How to Cite

Mace, MD, S. E., C. J. Doyle, MD, K. Askew, MD, S. Bradin, DO, M. Baker, MD, M. M. Joseph, MD, and A. Sorrentino, MD. “Planning Considerations for Persons With Access and Functional Needs in a disaster—Part 3: Medical CMIST and Recommendations”. American Journal of Disaster Medicine, vol. 13, no. 3, July 2018, pp. 207-20, doi:10.5055/ajdm.2018.0301.



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