Disasters and public health emergencies can stress health care systems to the breaking point and disrupt delivery of vital medical services. During such crises, hospitals and long-term care facilities may be without power; trained staff, ambulances, medical supplies and beds could be in short supply; and alternate care facilities may need to be used. Planning for these situations is necessary to provide the best possible health care during a crisis and, if needed, equitably allocate scarce resources.

Crisis Standards of Care: A Toolkit for Indicators and Triggers examines indicators and triggers that guide the implementation of crisis standards of care and provides a discussion toolkit to help stakeholders establish indicators and triggers for their own communities. Together, indicators and triggers help guide operational decision making about providing care during public health and medical emergencies and disasters. Indicators and triggers represent the information and actions taken at specific thresholds that guide incident recognition, response, and recovery. This report discusses indicators and triggers for both a slow onset scenario, such as pandemic influenza, and a no-notice scenario, such as an earthquake.

Crisis Standards of Care features discussion toolkits customized to help various stakeholders develop indicators and triggers for their own organizations, agencies, and jurisdictions. The toolkit contains scenarios, key questions, and examples of indicators, triggers, and tactics to help promote discussion. In addition to common elements designed to facilitate integrated planning, the toolkit contains chapters specifically customized for emergency management, public health, emergency medical services, hospital and acute care, and out-of-hospital care.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON CRISIS STANDARDS OF CARE: A TOOLKIT FOR INDICATORS AND TRIGGERS
• Reviewers
• User Guide
• Acronyms
• Summary
  • REPORT DESIGN AND ORGANIZATION
  • BACKGROUND ON CRISIS STANDARDS OF CARE
  • INDICATORS AND TRIGGERS
  • DISCUSSION TOOLKIT
  • REFERENCES
• 1. Introduction
  • STUDY GOALS AND METHODS
  • ORGANIZATION OF THE REPORT AND HOW TO USE THE TOOLKIT
  • PREVIOUS IOM WORK ON CRISIS STANDARDS OF CARE
  • CONTINUUM OF CARE: CONVENTIONAL, CONTINGENCY, AND CRISIS
  • A SYSTEMS APPROACH TO CATASTROPHIC DISASTER RESPONSE
  • IMPLEMENTATION OF THE DISASTER RESPONSE FRAMEWORK
  • THE NEED TO DEVELOP INDICATORS AND TRIGGERS
  • REFERENCES
• 2. Indicators and Triggers
  • WHAT ARE INDICATORS AND TRIGGERS
  • DEVELOPING USEFUL INDICATORS AND TRIGGERS
  • INDICATOR LIMITATIONS AND ISSUES
  • SYSTEMS-LEVEL CONSIDERATIONS FOR INDICATORS AND TRIGGERS
  • SUMMARY
  • REFERENCES
• 3. Toolkit Part 1: Introduction
  • TOOLKIT OBJECTIVE
  • USING THE TOOLKIT
  • SLOW-ONSET SCENARIO (PANDEMIC INFLUENZA)
  • NO-NOTICE SCENARIO (EARTHQUAKE)
  • OVERARCHING KEY QUESTIONS
  • WORKER FUNCTIONAL CAPACITY
  • REFERENCES
• 4. Toolkit Part 2: Emergency Management
  • INTRODUCTION
  • DISCUSSION AND DECISION-SUPPORT TOOL
  • REFERENCES
• 5. Toolkit Part 2: Public Health
  • INTRODUCTION
  • DISCUSSION AND DECISION-SUPPORT TOOL
  • REFERENCE
• 6. Toolkit Part 2: Behavioral Health
  • INTRODUCTION
  • DISCUSSION AND DECISION-SUPPORT TOOL
  • REFERENCE
• 7. Toolkit Part 2: Emergency Medical Services
  • INTRODUCTION
  • DISCUSSION AND DECISION-SUPPORT TOOL
  • REFERENCE
• 8. Toolkit Part 2: Hospital and Acute Care
  • INTRODUCTION
  • DISCUSSION AND DECISION-SUPPORT TOOL
  • REFERENCE
• 9. Toolkit Part 2: Out-of-Hospital Care
  • INTRODUCTION
  • DISCUSSION AND DECISION-SUPPORT TOOL
  • REFERENCES
• APPENDIXES
  • A Glossary
  • B Open Session Agenda
  • C Committee Biosketches

This study was supported by Contract No. HHSP23337003T between the National Academy of Sciences and the Department of Health and Human Services and Contract No. DTNH22-10-H-00287 between the National Academy of Sciences and the Department of Transportation’s National Highway Traffic Safety Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

IOM (Institute of Medicine). 2013. Crisis standards of care: A toolkit for indicators and triggers. Washington, DC: The National Academies Press.

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.