Excerpt

In recent years, a number of federal, state, and local efforts have taken place to develop crisis standards of care protocols and policies for use in conditions of overwhelming resource scarcity. Those involved in these efforts have begun to carefully consider these difficult issues and to develop plans that are ethical, consistent with the community’s values, and implementable during a crisis. These planning efforts are essential because, absent careful planning, there is enormous potential for confusion, chaos, and flawed decision making in a catastrophic public health emergency or disaster.

However, although these efforts have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. Furthermore, the efforts have mainly been taking place independently, leading to a lack of consistency across neighboring jurisdictions and unnecessary duplication of effort. Lastly, many states have not yet substantially begun to develop policies and protocols for crisis standards of care during a mass casualty event.

These issues prompted the Institute of Medicine’s (IOM’s) Forum on Medical and Public Health Preparedness for Catastrophic Events (Preparedness Forum) to organize a series of regional workshops on this topic. These workshops were held in Irvine, CA; Orlando, FL; New York, NY; and Chicago, IL, between March and May of 2009.

Contents

• The National Academies
• Workshop Planning Committee
• Forum on Medical and Public Health Preparedness for Catastrophic Events
• Reviewers
• Introduction
• Forum and Workshop Objectives
• Related IOM Work on Crisis Standards of Care
  • Definition of “Crisis Standards of Care”
  • Other Related Work
• Crisis Standards of Care Protocols
  • Developing Crisis Standards of Care Protocols
  • Who Makes the Plan?
• Continuum of Surge Capacity and Standards of Care
  • Conventional, Contingency, and Crisis Standards of Care
  • Stages of Care in the North Dakota Plan
• Clinical Operations
  • Indicators
  • Triggers
  • Triage
  • Alternate Care Facilities
  • Broadening the Scope: Emergency Medical Services, Community Health, and Other Components of the Health System
  • Resource Availability and Distribution
  • Pediatrics and Other At-Risk Populations
  • Palliative Care
  • Mental Health Care
  • Training
• Provider Involvement and Engagement
  • Engaging Frontline Providers
  • Hospital Officials
• Public Engagement and Education
  • Changing the Culture of Preparedness
  • Elected Officials and the Media
• Developing Intrastate and Interstate Cooperation and Consistency
  • FEMA Regions
  • The All Hazards Consortium
  • The Interstate Disaster Medical Cooperative
  • Village-to-Village Communication
  • Communications and Consistency
• The Role of the Federal Government and National Leadership
  • The Veterans Health Administration
  • The Department of Defense
• Ethical Considerations
• Legal Issues for Crisis Standards of Care
  • Legal Liability
  • Credentialing and Scope of Practice
  • EMTALA and HIPAA
  • Legal Triage
  • Education and Training
• Conclusion
• Appendixes
  • A References
  • B Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report
  • C Workshop Agendas
  • D Participant Feedback Survey Responses
  • E Biographical Sketches of Workshop Planning Committee Members, Invited Speakers, and Panelists

Clare Stroud, Bruce M Altevogt, Lori Nadig, and Matthew Hougan, Rapporteurs.

This project was supported by contracts between the National Academy of Sciences and the American College of Emergency Physicians, the American Hospital Association, the American Medical Association, the American Nurses Association, the Association of State and Territorial Health Officials, the Centers for Disease Control and Prevention (Contract No. 200-2005-13434 TO #6), the Department of the Army (Contract No. W81XWH-08-P-0934), the Department of Health and Human Services’ Agency for Healthcare Research and Quality (Contract No. HHSP233200800498P), the Department of Health and Human Services’ National Institutes of Health (Contract No. N01-OD-4-2139 TO #198), the Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (Contract No. HHSP233200900680P), the Department of Homeland Security’s Federal Emergency Management Agency (Contract No. HSFEHQ-08-P-1800), the Department of Homeland Security’s Office of Health Affairs (Contract No. HSHQDC-07-C-00097), the Department of Veteran Affairs (Contract No. V101(93)P-2136 TO #10), the Emergency Nurses Association, the National Association of Chain Drug Stores, the National Association of County and City Health Officials, the National Association of Emergency Medical Technicians, the Pharmaceutical Research and Manufacturers of America, the Robert Wood Johnson Foundation, and the United Health Foundation.

Suggested citation:

IOM (Institute of Medicine). 2010. Crisis standards of care: Summary of a workshop series. Washington, DC: The National Academies Press.

The views presented in this publication are those of the editors and attributing authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.