2003 – On February 28, 2003, President Bush issues HSPD-5 outlining the system for management of domestic incidents (man-made and natural disasters). HSPD-5 mandates the creation and adoption of the National Response Plan (NRP). 2003 – On September 30, 2003, the National Response Plan is published and adopted by all Federal agencies. 2003 – On December 17, 2003, President Bush issues HSPD-8, outlining the new framework for national preparedness and creating the National Incident Management System (NIMS). 2004 – In February, 2004 the AAPS reports to the American Board of Physician Specialties (ABPS) that the expert panel, supported by the available literature and recent HSPDs, has determined that there is a sufficient body of unique knowledge in disaster medicine to designate the field as a discrete specialty. ABPS empanels a board of certification to determine if board certification is appropriate in this new specialty. 2004 – On April 28, 2004, President Bush issues HSPD-10, also known as the plan for Biodefense for the 21st Century which calls for healthcare to implement surveillance and response capabilities to combat the threat of terrorism. 2004 – Hurricanes Charlie, Francis, Ivan and Jeanne batter the state of Florida, resulting in the largest disaster medical response since Hurricane Andrew. 2005 – Hurricane Katrina batters the Gulf Coast of the United States, destroying multiple coastal cities. For the first time in NDMS history, the entire NDMS system is deployed for a single disaster medical response. Among the many lessons learned in field operations following Hurricane Katrina are the need for cellular autonomy under a central incident command structure and the creation of continuous integrated triage for the management of massive patient surge. The lessons learned in the Hurricane Katrina response would be applied less than a month later following Hurricane Rita and again following Hurricane Wilma and the Indonesian tsunami. 2005 – In late October 2005, the American Board of Disaster Medicine (ABODM) and the American Academy of Disaster Medicine (AADM) are formed for scholarly study, discussion, and exchange in the field of disaster medicine, as well as to oversee board certification in disaster medicine. 2006 – In June 2006, the Institute of Medicine publishes three reports on the state of emergency Health care in the United States. Among the condemnations of emergency care is the lack of substantial improvement in disaster preparedness, or "cross-silo" coordination. 2006 – On September 17, 2006, the NIMS Integration Center