Dan Hanfling MD, Bruce M. Altevogt PhD, Kristin Viswanathan, and Lawrence O. Gostin JD
In 2011 alone, a tornado devastated Joplin, Missouri, and earthquakes rocked New Zealand and Japan, underscoring how quickly and completely health systems can be overwhelmed. Disasters can stress health care systems to the breaking point and disrupt delivery of vital medical services.
At the request of the HHS, the IOM formed a committee in 2009, which developed guidance that health officials could use to establish and implement standards of care during disasters. In its first report, the committee defined “crisis standards of care” (CSC) as a state of being that indicates a substantial change in health care operations and the level of care that can be delivered in a public health emergency, justified by specific circumstances. During disasters, medical care must promote the use of limited resources to benefit the population as a whole.
In this report, the IOM examines the effect of its 2009 report, and develops vital templates to guide the efforts of professionals and organizations responsible for CSC planning and implementations. Integrated planning for a coordinated response by state and local governments, EMS, health care organizations, and health care providers in the community is critical to successfully responding to disasters. The report provides a foundation of underlying principles, steps needed to achieve implementation, and the pillars of the emergency response system, each separate and yet together upholding the jurisdictions that have the overarching authority for ensuring that CSC planning and response occurs.
Bruce M. Altevogt PhD, Clare Stroud PhD, Sarah L. Hanson, Dan Hanfling MD, and Lawrence O. Gostin JD
The influenza pandemic caused by the 2009 H1N1 virus underscores the immediate and critical need to prepare for a public health emergency in which thousands, tens of thousands, or even hundreds of thousands of people suddenly require and seek medical care in communities across the United States. In the event of such emergencies, officials rely on standards of care policies and protocols to protect the public’s health. As the nation prepares not only for the 2009 influenza pandemic, but for any disaster scenario in which the health system may be stressed to its limits, it is important to describe the conditions under which standards of care would change due to shortage of critical resources.
At the request of the Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services, the Institute of Medicine convened a committee to develop guidance for crisis standards of care that should apply in disaster situations—both naturally occurring and manmade—under scarce resource conditions. The committee’s report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, is focused on articulating current concepts and guidance that can assist state and local public health officials, healthcare facilities, and professionals in the development of systematic and comprehensive policies and protocols for crisis standards of care in disasters where resources are scarce. In addition, the committee provides guidance to clinicians, health care institutions, and state and local public health officials for how those crisis standards of care should be implemented in a disaster situation.