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U.S. Department of Health and Human Services

At-Risk Individuals

At-risk individuals are people with access and functional needs that may interfere with their ability to access or receive medical care before, during, or after a disaster or emergency. Irrespective of specific diagnosis, status, or label, the term “access and functional needs” is a broad set of common, crosscutting, access, and function-based needs.

  • Access-based needs requires ensuring that resources are accessible to all individuals, such as social services, accommodations, information, transportation, medications to maintain health, and so on.
  • Function-based needs refer to restrictions or limitations an individual may have that requires assistance before, during, and/or after a disaster or public health emergency.

The 2013 Pandemic and All-Hazards Preparedness Reauthorization Act defines at-risk individuals as children, older adults, pregnant women, and other individuals who may need additional response assistance. Examples of these populations include individuals with disabilities, individuals who live in institutional settings, individuals from diverse cultures, individuals who have limited English proficiency or are non-English speaking, individuals who are transportation disadvantaged, individuals experiencing homelessness, individuals who have chronic medical disorders, and individuals who have pharmacological dependency.

At-risk individuals may have a number of additional needs that must be considered in planning for, responding to, and recovering from a disaster or emergency. A recommended approach for integrating the access and functional needs of these individuals is the CMIST Framework as follows:

  • Communication – Individuals who may have limitations that interfere with the receipt of and response to information require information be provided in an appropriate and accessible format. This can include individuals who are deaf or hard of hearing, individuals who speak American Sign Language, individuals who have limited or no English proficiency, individuals who are blind or have low vision, and individuals who have cognitive or physiological limitations.
  • Maintaining Health – Individuals who may require Personal Assistance Services (or personal care assistance) in maintaining their activities of daily living such as eating, dressing, grooming, transferring, and toileting.
  • Independence – Includes individuals who function independently if they have their assistive devices, such as consumable medical supplies (diapers, formula, bandages, ostomy supplies, etc.), durable medical equipment (wheelchairs, walkers, scooters, etc.), and/or service animals.
  • Services and Support – Includes support for individuals with behavioral health needs, those who have psychiatric conditions (such as dementia, Alzheimer's disease, Schizophrenia, severe mental illness), pregnant women, nursing mothers, and infants, and children.
  • Transportation – Includes individuals with transportation needs because of age, disability, temporary injury, poverty, addiction, legal restriction, or those who do not have access to a vehicle. This requires coordination to ensure access to mass transit and accessible vehicles such as para-transit.

The CMIST Framework provides a flexible, cross-cutting approach to defining at-risk individuals to address a broad set of common access and functional needs irrespective of specific diagnoses, status, or labels (e.g., pregnant women, children, elderly). Ultimately, individuals with access and functional needs must be addressed in all federal, territorial, tribal, state, and local emergency and disaster plans.

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  • This page last reviewed: March 01, 2015