Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality

Public Health Emergency Preparedness: Providing Mass Medical Care with Scarce Resources

Slide Presentation by Ann Knebel, R.N., D.N.Sc., FAAN

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Broadcast on November 29, 2006, the Web conference Providing Mass Medical Care With Scarce Resources: Strategies and Tools for Community Planners gave an overview of the community planning guide and provided planners at the institutional, State, and Federal levels with valuable insights and information that will help them plan for and respond to a Mass Casualty Event (MCE).

Ann Knebel, R.N., D.N.Sc., FAAN, Deputy Director for Preparedness Planning, Office of Preparedness and Emergency Operations, Office of Public Health Emergency Preparedness, U.S. Department of Health and Human Services, delivered a presentation during the conference entitled Application of Concepts to a Pandemic Case Study. This is the text version of Dr. Knebel's slide presentation. Select to access the PowerPoint® Slides (3 MB).

Application of Concepts to a Pandemic Case Study

Ann Knebel, R.N., D.N.Sc., FAAN
Captain, U.S. Public Health Service

Slide 1

The Next Pandemic: What Can We Expect?

A black and white photo of a child accompanies an old poster about influenza.

Slide 2

Estimates of Impact of 1918-like Event

Event Estimate
Illness 90 million, 30 percent
Outpatient medical care 45 million, 50 percent
Hospitalization 9,900,000
ICU care 1,485,000
Mechanical ventilation 745,500
Deaths 1,903,000

Slide 3

Containment Strategies

Old photos show police officers and street sweepers wearing medical masks.

Slide 4

Community-based Interventions

  1. Delay outbreak peak.
  2. Decompress peak burden on hospitals slash infrastructure.
  3. Diminish overall cases and health impacts.

On a line graph, the x-axis is labeled Days Since First Case and the y-axis is labeled Daily Cases. A line labeled Pandemic Outbreak: No Intervention has a high and early peak.

A line labeled Pandemic Outbreak: With Intervention has a peak about half as high and about half again as long after the first case. The area under this line is shaded, and a vertical line runs from the x-axis to about the peak. An arrow labeled Number 1 points rightward from near the label for the first line. An arrow labeled Number 2 points downward to near the label for the second line. The shaded area right of the vertical line is labeled Number 3.

Slide 5

Seasonal Flu versus Pandemic Flu

  • Seasonal
    • Predictable patterns.
    • Some immunity.
    • Healthy adults not at serious risk.
    • Health systems adequate to meet needs.
  • Pandemic
    • Occurs rarely.
    • Little or no immunity.
    • Health people may be at increased risk.
    • Health systems may be overwhelmed.
  • Slide 6

    Role of the Primary Care Provider

    An old photo shows a large room full of patients on beds. The caption reads: "Emergency hospital during influenza epidemic, Camp Funston, Kansas." Shows head-to-foot bed arrangement.

    Source: National Museum of Health and Medicine, Armed Forces Institute of Pathology, NCP 1603.

    Slide 7

    Role of Home Care

    • Significant role for primary care providers.
    • Family members will play a significant role.
    • Planning should consider...

    Slide 8

    Ethical Principles

    • Greatest good for greatest number.
    • Other principles important to consider.
    • Ethical process requires...
    • Difficult choices will have to be made; the better we plan, the more ethically sound the choices will be.

    Slide 9

    Legal Issues

    • Can the local community declare a disaster?
    • Advance planning and issue identification are essential, but not sufficient.
    • Legal Triage: planners should partner with legal community during disasters.

    Slide 10

    Daily Deaths, Ohio, 1918

    On an old bar chart, the x-axis shows days in October and November and the y-axis gives numbers in increments of 60. The highest levels are in late October.

    Source: Brodrick OL. Influenza and pneumonia deaths in Ohio in October and November, 1918. Ohio Public Health Journal 1919; volume 10: pages 70-2.

    Slide 11

    Take-Home Messages

    • Community-level planning should be going on now, including the broad range of stakeholders.
    • Regional planning and coalition building serve as "force multipliers."
    • Engage the community in a transparent planning process and communication strategy.

    Slide 12

    More Information

    The slide shows a screen shot taken from the Web site


    Current as of November 2006

    Internet Citation:

    Application of Concepts to a Pandemic Case Study. Public Health Emergency Preparedness: Providing Mass Medical Care with Scarce Resources. Web Conference, broadcast on November 29, 2006. Agency for Healthcare Research and Quality, Rockville, MD.


    The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care