ABSTRACT
According to Haning et al. (2012), catastrophic disasters occurring in 2011 in the United States and worldwide have demonstrated that even prepared communities can be overwhelmed. Those disasters range from the tornado in Joplin, Missouri, and the earthquake and tsunami in Japan to the earthquake in New Zealand. Successful disaster response depends on coordination and integration across the full system of the key stakeholder groups: state and local governments, emergency medical services (EMS), public health, emergency management, hospital facilities, and the outpatient sector. Vertical integration among agencies at the federal, state, and local levels is also crucial. At the cornerstone of this coordination and integration is a foundation of ethical obligations and the legal authorities and regulatory environment that allow for shifts in expectations of the best possible response based on the context of the disaster in which that response is being executed.
