Disaster Medicine and Public Health Preparedness

Research Article

Definition and Functions of Health Unified Command and Emergency Operations Centers for Large-scale Bioevent Disasters Within the Existing ICS

Frederick M. Burkle Jr, Edbert B. Hsu, Michael Loehr, Michael D. Christian, David Markenson, Lewis Rubinson and Frank L. Archer


The incident command system provides an organizational structure at the agency, discipline, or jurisdiction level for effectively coordinating response and recovery efforts during most conventional disasters. This structure does not have the capacity or capability to manage the complexities of a large-scale health-related disaster, especially a pandemic, in which unprecedented decisions at every level (eg, surveillance, triage protocols, surge capacity, isolation, quarantine, health care staffing, deployment) are necessary to investigate, control, and prevent transmission of disease. Emerging concepts supporting a unified decision-making, coordination, and resource management system through a health-specific emergency operations center are addressed and the potential structure, function, roles, and responsibilities are described, including comparisons across countries with similar incident command systems. (Disaster Med Public Health Preparedness. 2007;1:135–141)

(Received July 01 2007)

(Accepted August 06 2007)

Key Words

  • emergency operations center;
  • incident command system;
  • triage;
  • surge capacity;
  • biological;
  • pandemics/epidemics

Dr Burkle is with the Harvard Humanitarian Initiative, Harvard University School of Public Health; Dr Hsu is with the Department of Emergency Medicine, Johns Hopkins University Medical Institutions; Mr Loehr and Dr Rubinson are with the Healthcare Coalition, Public Health Seattle-King County; Dr Christian is with Mount Sinai Hospital and University Health Network, University of Toronto; Dr Markenson is with the Departments of Public Health and Pediatrics, New York Medical College; and Dr Archer is with the Department of Community Emergency Health & Paramedic Practice, Monash University, Melbourne.