Crisis standards of care: A model of public engagement to elicit community values and priorities concerning the allocation of scarce medicial resources during pandemics and mass casualty events

The Massachusetts Department of Public Health (MDPH) has been working to develop “Crisis Standards of Care” (CSC) for pandemics and mass casualty events. Since 2006, MDPH has convened two advisory groups comprised of ethicists, lawyers, clinicians, first responders and public health professionals to assist this process. The first group examined the ethical, legal and practical dimensions of providing healthcare during extreme public health emergencies and helped establish the underlying principles upon which state policies could be developed for allocating healthcare resources when demand for services temporarily exceeds the system's capacity to provide them according to normal standards of care. Applying these principles, the second group drafted specific CSC guidelines and decision-making frameworks. Knowing that even the best preparedness policies will fall short in a crisis without the assent and cooperation of an informed public, MDPH recently launched a statewide public engagement process through which it is reaching out to an even more diverse group of stakeholders--including traditionally vulnerable and underserved populations within the general public--for consultation on the draft guidelines. It will use the information it receives about community values and priorities to finalize CSC guidelines for Massachusetts. MDPH is exploring a variety of forums, both actual and electronic, to reach a broad cross-section of the community and to provide opportunities for meaningful discussion around these challenging issues. In designing this process, MDPH has built off of other states' earlier initiatives while originating some strategies of its own. This presentation offers a discussion of public engagement best practices.