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 seek and require medical care in communities across the United States.

Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations draws from a broad spectrum of expertise--including state and local public health, emergency medicine and response, primary care, nursing, palliative care, ethics, the law, behavioral health, and risk communication--to offer guidance toward establishing standards of care that should apply to disaster situations, both naturally occurring and man-made, under conditions in which resources are scarce.

This book explores two case studies that illustrate the application of the guidance and principles laid out in the report. One scenario focuses on a gradual-onset pandemic flu. The other scenario focuses on an earthquake and the particular issues that would arise during a no-notice event.

Outlining current concepts and offering guidance, this book will prove an asset to state and local public health officials, health care facilities, and professionals in the development of systematic and comprehensive policies and protocols for standards of care in disasters when resources are scarce. In addition, the extensive operations section of the book provides guidance to clinicians, health care institutions, and state and local public health officials for how crisis standards of care should be implemented in a disaster situation.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON GUIDANCE FOR ESTABLISHING STANDARDS OF CARE FOR USE IN DISASTER SITUATIONS
• Reviewers
• [Letter to Nicole Lurie, M.D., M.S.P.H.]
• BACKGROUND
  • 2009 H1N1 Influenza Pandemic and Other Public Health Emergencies and Disasters
  • Scarce Resources, Demand for Healthcare Services, and Standards of Care
  • State and Local Policies and Protocols
• METHODS
• CRISIS STANDARDS OF CARE: THE VISION
  • Five Key Elements of Crisis Standards of Care Protocols
• DEVELOPING CRISIS STANDARDS OF CARE PROTOCOLS: A STATE PUBLIC HEALTH AUTHORITY PROCESS
• ETHICAL FRAMEWORK
  • Ethical Norms
  • Ethical Process
  • Applying the Ethics Framework: Ventilator Allocation
• COMMUNITY AND PROVIDER ENGAGEMENT, EDUCATION, AND COMMUNICATION
  • Preincident Community Engagement
  • Community Engagement to Improve Resiliency
  • Improving Trust with Vulnerable Populations
• LEGAL ISSUES IN EMERGENCIES
  • Distinguishing Medical and Legal Standards of Care and Scope of Practice
  • The Changing Legal Environment During Declared Emergencies
• OPERATIONAL IMPLEMENTATION OF CRISIS STANDARDS OF CARE
  • Clinical Care in Disasters
  • Disaster Mental Health Crisis Standards of Care
  • Palliative Care Planning for Crisis Standards of Care
  • Crisis Standards of Care Indicators
  • Crisis Standards of Care Implementation Criteria
  • Crisis Standards of Care Triage
  • Prerequisite Command, Control, and Coordination Elements
  • Crisis Standards of Care Operations
  • Decision Tools and Resource Use Guidance
• CONCLUSION
• A References
• B. Glossary
• C Crisis Standards of Care Implementation Guidance Scenarios
• D Workshop Agenda
• E Committee Biographical Information

This study was requested by the Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, and supported by Contract No. HHSP23320042509XI between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2009. Guidance for establishing crisis standards of care for use in disaster situations: A letter report. 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.