Using the C-MIST Framework

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Using the C-MIST Framework in Emergency Planning

Alice Frame, MA - MDHHS Disabilities Health Unit Coordinator

In an emergency, having a standardized system for identifying individuals with unique needs can save time, energy, and lives. The C-MIST framework, based on functional needs, divides people with disabilities into five categories based on type of need: Communication, Medical, Independence, Supervision, and Transportation.  Each category has an icon for easier identification, allowing a person’s needs to be recognized by every individual who assists them during and following an emergency. Using this system allows for rapid identification of individuals with functional needs and standardizes the identification system into a language all responders can understand and use.

The C-MIST framework was first developed in 2007 by June Isaacson Kailes and Alexandra Enders.  The reason for the development of this new framework was to provide a more flexible model that helped determine needs that may overlap (Kailes & Enders, 2007).  The authors argue that those who have a disability should not be separated into a category all their own.  While “special needs” is a term that is no longer used, even the term “at-risk” can unfairly categorize people.  Those with disabilities are part of every segment of society.  The C-MIST framework more broadly categorizes disabilities to make planning for a wide range possible. 

Outlined below are the five categories:

Communication: this category describes people who have difficulty or limitations in communication, such as people who have limited or no ability to hear, speak, understand, or see. These individuals may not be able to process standard communications coming out during an emergency and may require information to be conveyed in an alternative format. They also may need assistance expressing their questions or concerns.

Medical: this category describes individuals with complex medical needs who may require assistance in daily activities (such as eating or grooming) or assistance in managing chronic or terminal health conditions. This includes individuals ls who use specialized medical equipment for daily activities or illness management (such as feeding tubes, IV therapy, chest ports, dialysis, oxygen, or other life-sustaining equipment).  Rapid identification of these individuals is incredibly important to prevent worsening of medical conditions.

Independence: this category includes individuals who may have difficultly functioning independently during an emergency if they become separated from assistive devices or equipment. Such equipment can include mobility aids, communication aids, medical equipment, or service animals. Identifying these individuals and ensuring they have access to their assistive devices allows them to maintain their independence and may prevent functional limitations in other categories. For example, if an individual no longer has their hearing aid or runs out of battery, they may then also have a communication limitation.  Making sure they have a hearing aid that meets their needs prevents that communication barrier and the need for alternative methods of communicating with them.

Supervision: this category includes individuals who may require someone with them at all times for safety and comfort. This can include individuals with memory issues from Alzheimer’s or dementia, individuals with psychiatric conditions, individuals with addiction, individuals with brain injury, or individuals with intellectual disabilities. Supervised settings can help prevent wandering, self-harm, increased anxiety or stress, or addiction relapse. It’s important to note that having a mental illness does NOT automatically mean a person requires supervision or assistance – while some may feel more comfortable and stable in a protected environment if they are experiencing an episode or magnified symptoms, many people with treated and managed mental illness will be able to function on their own.

Transportation: this category includes individusl who are unable to travel or drive on their own due to disability (such a mobility limitations or blindness), age, legal restrictions (such as those with DUI convictions or individuals with a history of seizures), or lack of access to a vehicle. Planning ahead of time for this can prevent chaos in an emergency.

Using this system to help evaluate and identify the unique needs of individuals in an emergency eliminates confusion and establishes a common protocol that all first responders can use.  


Kailes, J. I., & Enders, A. (2007). Moving Beyond “Special Needs”: A Function-Based Framework for Emergency Management and Planning. Journal of Disability Policy Studies, 17(4), 230–237.