The CMIST Framework

At-risk individuals may have a number of additional needs that must be considered in planning for, responding to, and recovering from a disaster or public health emergency. The CMIST Framework is a recommended approach for integrating the Access and Functional Needs (AFN) of these individuals.

CMIST is an acronym for the following five categories: Communication, Maintaining health, Independence, Support and Safety, and Transportation. The CMIST Framework provides a flexible, crosscutting approach for planning to address a broad set of common AFN without having to define a specific diagnosis, status, or label.

The framework is an acronym composed of following five categories:


Individuals who speak sign language, who have limited English proficiency (LEP), or who have limited ability to speak, see, hear, or understand

People with communication needs may have limited ability to hear announcements, see signs, understand messages, or verbalize their concerns.

Maintaining Health

Individuals who may require specific medications, supplies, services, durable medical equipment, electricity for life-maintaining equipment, breastfeeding and infant/childcare, or nutrition, etc.

Early identification and planning for AFN can help to reduce the negative impacts of a disaster on individuals’ health. This includes:

  • Maintaining chronic health conditions
  • Minimizing preventable medical conditions
  • Avoiding decompensation or worsening of an individual’s health status


Individuals who function independently with assistance from mobility devices or assistive technology, vision and communication aids, services animals, etc.

Independence is the outcome of ensuring that a person’s access and functional needs are addressed as long as they are not separated from their devices, assistive technology, service animals, etc.

Support and Safety

Some individuals may become separated from caregivers and need additional personal care assistance; experience higher levels of distress and need support for anxiety, psychological, or behavioral health needs; or require a trauma-informed approach or support for personal safety.

Early identification and planning for AFN can help to reduce the negative impacts of a disaster on individuals’ wellbeing. Some people may have lost caregiver assistance and require additional support; some individuals may find it difficult to cope in a new or strange environment or have difficulty understanding or remembering; and some individuals may have experienced trauma or be victims of abuse.


Individuals who lack access to personal transportation, are unable to drive due to decreased or impaired mobility that may come with age and/or disability, temporary conditions, injury, or legal restriction

Disasters can significantly reduce transportation options, inhibiting individuals from accessing services, staying connected, etc. Disaster planning requires coordination with mass transit and accessible transportation services providers.

Learn More

Addressing AFN is a crucial part of comprehensive disaster planning for the whole community and is mandated for inclusion in federal, state, local, tribal, and territorial public health emergency plans. To learn more about addressing the AFN of individuals and the CMIST Framework, you may take the free HHS/ASPR Access and Functional Needs Web-Based Training.