Disaster Medicine and Public Health Preparedness

Research Article

Developing National Standards for Public Health Emergency Preparedness With a Limited Evidence Base

Christopher Nelson c1, Ed Chan, Anita Chandra, Paul Sorensen, Henry H. Willis, Stephanie Dulin and Kristin Leuschner


Objective: The paucity of evidence and wide variation among communities creates challenges for developing congressionally mandated national performance standards for public health preparedness. Using countermeasure dispensing as an example, we present an approach for developing standards that balances national uniformity and local flexibility, consistent with the quality of evidence available.

Methods: We used multiple methods, including a survey of community practices, mathematical modeling, and expert panel discussion.

Results: The article presents recommended dispensing standards, along with a general framework that can be used to analyze tradeoffs involved in developing other preparedness standards.

Conclusions: Standards can be developed using existing evidence, but would be helped immensely by a stronger evidence base.

(Disaster Med Public Health Preparedness. 2010;4:285-290)

(Received April 12 2010)

(Accepted September 24 2010)

Key Words:

  • performance standards;
  • countermeasure dispensing;
  • Strategic National Stockpile;
  • public health preparedness;
  • emergencies;
  • community disaster response;
  • drug therapy;
  • evidence-based practice;
  • task performance and analysis


c1 Correspondence: Address correspondence and reprint requests to Dr Christopher Nelson, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138 (e-mail: cnelson@rand.org).

Author Affiliations: Dr Nelson, Dr Chan, Dr Chandra, Dr Sorensen, Dr Willis and Dr Leuschner are with the RAND Corporation. Ms Dulin is with the Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Division of Strategic National Stockpile.