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U.S. Department of Health and Human Services

Executive Summary

Medical and public health systems in the United States must prepare for major emergencies or disasters involving human casualties. Such events will severely challenge the ability of healthcare systems to adequately care for large numbers of patients (surge capacity) and/or victims with unusual or highly specialized medical needs (surge capability). In addition, medical and public health systems can expect incidents that significantly impact their usual operations, as occurred with Hurricane Katrina. These so-called "mass effect" events can have devastating consequences for medically fragile segments of society and those living with chronic health conditions. Limited or no access to routine healthcare services can cause these populations to rapidly decompensate, producing a downstream surge of demand for acute care that can overwhelm local capabilities. The first step in addressing medical surge and medical system resiliency is to implement systems that can effectively manage medical and health response, as well as the development and maintenance of preparedness programs.

The Medical Surge Capacity and Capability (MSCC) Management System describes a management methodology based on valid principles of emergency management and the Incident Command System (ICS). Medical and public health disciplines may apply these principles to coordinate effectively with one another, and to integrate with other response organizations that have established ICS and emergency management systems (fire service, law enforcement, etc.). This promotes a common management system for all response entities—public and private—that may be brought to bear in an emergency. In addition, the MSCC Management System guides the development of public health and medical response that is consistent with the National Incident Management System (NIMS).

The MSCC Management System emphasizes responsibility rather than authority alone for assigning key response functions and advocates a management-by-objectives approach. In this way, the MSCC Management System describes a framework of coordination and integration across six tiers of response:

  • Management of Individual Healthcare Assets (Tier 1): A well-defined ICS to collect and process information, to develop incident plans, and to manage decisions is essential to maximize MSCC. Robust processes
    must be applicable both to traditional hospital participants and to other healthcare organizations (HCOs) that may provide "hands on" patient care in an emergency (e.g., outpatient clinics, community health centers, private physician offices, and others). Thus, each healthcare asset must have information management processes to enable integration among HCOs (at Tier 2) and with higher management tiers.
  • Management of a Healthcare Coalition (Tier 2): Coordination among local healthcare assets is critical to provide adequate and consistent care across an affected jurisdiction.[4] The healthcare coalition provides a central integration mechanism for information sharing and management coordination among healthcare assets, and also establishes an effective and balanced approach to integrating medical assets into the jurisdiction's ICS.
  • Jurisdiction Incident Management (Tier 3): A jurisdiction's ICS integrates healthcare assets with other response disciplines to provide the structure and support needed to maximize MSCC. In certain events, the jurisdictional ICS promotes a unified incident command approach that allows multiple response entities, including public health and medicine, to assume significant management responsibility.
  • Management of State Response (Tier 4): State Government participates in medical incident response across a range of capacities, depending on the specific event. The State may be the lead incident command authority, it may provide support to incidents managed at the jurisdictional (Tier 3) level, or it may coordinate multijurisdictional incident response. Important concepts are delineated to accomplish all of these missions, ensuring that the full range of State public health and medical resources is brought to bear to maximize MSCC.
  • Interstate Regional Management Coordination (Tier 5): Effective mechanisms must be implemented to promote incident management coordination between affected States. This ensures consistency in regional response through coordinated incident planning, enhances information exchange between interstate jurisdictions, and maximizes MSCC through interstate mutual aid and other support. Tier 5 incorporates existing instruments, such as the Emergency Management Assistance Compact (EMAC), and describes established incident command and mutual aid concepts to address these critical needs.
  • Federal Support to State, Tribal, and Jurisdiction Management (Tier 6): Effective management processes at the State (Tier 4) and jurisdiction (Tier 3) levels facilitate the request, receipt, and integration of Federal public health and medical resources to maximize MSCC. The Federal public health and medical response is described, emphasizing the management aspects that are important for State and local managers to understand.

The tiers of the MSCC Management System do not operate in a vacuum. They must be fully coordinated with each other, and with the non-medical incident response, for medical and public health resources to provide maximum MSCC. The processes that promote this coordination and integration enable medicine and public health to move beyond their traditional support roles (for example, as an Emergency Support Function) and become competent participants in large-scale medical incident management.

Response systems, by necessity, are adapted to address historically effective capabilities, available resources, specific laws and regulations, and the medical and public health infrastructure in a given area. The MSCC Management System is not intended as an "all or nothing" requirement that ignores this reality, and the specific tiers and management processes will not apply equally in all States, Tribal Nations, and jurisdictions. Regardless of how a response system is configured, however, planners must ensure that all key management functions are addressed. The MSCC Management System provides a model to conduct this assessment, and provides formative guidance when developing or revising response management capabilities.

Many of the tenets of the MSCC Management System are not easily achieved. For example, garnering support and participation from medical clinics and private physician offices, while laudable, is by no means a simple task to accomplish. Because the private medical community is so diverse and disconnected, there is wide variation in motivation and constraints to implementing these processes. This may cause incomplete realization of some of the tier goals and objectives. Nevertheless, the MSCC Management System provides an overarching model that can help to organize seemingly disparate preparedness efforts. It may also assist in illustrating, for any reluctant medical administrators, the critical role played by private medical assets.

The NIMS makes it increasingly important for medicine and public health to adopt response systems based on ICS principles. NIMS establishes core concepts and organizational processes based on ICS to allow diverse disciplines from all levels of government and the private sector to work together in response to domestic hazards. NIMS compliance is required of all Federal departments and agencies, as well as State, Tribal, and jurisdictional organizations that seek Federal preparedness assistance (grants, contracts, etc.). With its basis in ICS, the MSCC Management System helps to ensure that medical and public health organizations develop NIMS-consistent relationships, strategies, processes, and procedures, and become equal partners that are fully integrated into the emergency response community.


  1. The term jurisdiction in this context refers to a geographic area’s local government, which commonly has the primary role in emergency or disaster response.

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  • This page last reviewed: February 14, 2012