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PLoS Curr. 2018 Oct 1;10. pii: ecurrents.dis.f272fef04c7222a546e03450221a69d1. doi: 10.1371/currents.dis.f272fef04c7222a546e03450221a69d1.

Process of Development of a County-wide Crisis Care Plan - Riverside County, California, 2016-7.

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Department of Public Health, Riverside University Health System, Riverside, CA, USA.
Emergency Management Department, County of Riverside, Riverside, CA, USA.
Department of Public Health, Riverside University Health System, Riverside, CA, USA; Emergency Management Department, County of Riverside, Riverside, CA, USA.



Disasters with substantial impacts to the health care and public health systems can have multiple reverberating effects, including the need to alter the medical standard of care as well as centrally control scarce medical resources. A current crisis care plan can help to establish an ethical and operational framework for stakeholders before such a disaster takes place. However, there are few examples of such a plan that cover large areas and health jurisdictions. This article describes the process of developing such a "Crisis Care Plan."


Plan developers from the Riverside County Department of Public Health and Riverside County Emergency Management Department first developed an ethical framework for decision making, followed by the development of a full operational crisis care plan with conditions for activation, life cycle and deactivation. The plan was then reviewed by major county stakeholders, including local emergency medical services, the county medical association and the hospital association, and additional comments incorporated. Before the final plan is implemented it will be submitted for public review and provider training materials will be developed.


The development of a prerequisite ethical framework helped to reduce the risk that the operational plan would cause or exacerbate care disparities by informing a blinded, objective process for evaluating resource requests centrally prior to distribution. The ethical framework served to establish the grounding principle of all lives having an equal claim on value. Stakeholders recognized the need for such a Crisis Care Plan and agreed with the underlying ethical principles. Stakeholders also contributed useful recommendations to enable the plan to operate in as successful a manner as possible under the difficult conditions within which it would exist.


The development of a clear ethical framework and the early identification and involvement of stakeholders can enable even very large health jurisdictions to construct crisis care plans that enable the best care under difficult circumstances, while protecting individual rights and incorporating the concerns of the public and the health care community.

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