268223 Conceptualizing a Framework for Crisis Standards of Care

Tuesday, October 30, 2012 : 2:30 PM - 2:50 PM

Dan Hanfling, MD , Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA
Tia Powell, MD , Montefiore-Einstein Center for Bioethics, Albert Einstein College of Medicine, Bronx, NY
Umair A. Shah, MD, MPH , Deputy Director, Harris County Public Health and Environmental Services, Houston, TX
Donna Levin, BA, JD , Office of General counsel, Massachusetts Department of Public Heatlh, Boston, MA
Background/Purpose: Because crisis standards of care (CSC) are just one aspect of broader disaster planning and response efforts, a systems approach to planning for and implementing CSC is required to integrate all of the values and responders necessary to achieve the best outcomes for the community as a whole.

Methods: The Institute of Medicine's Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations culled relevant literature, recent responses to catastrophic disasters, and the foundation of its earlier work (the 2009 Letter Report) to develop a comprehensive systems approach to disaster preparedness and response in general, and planning for and implementing CSC specifically.

Results/Outcomes: The committee's systems framework is built on ethical obligations and the legal authorities and regulatory environment in place. Because successful disaster response relies on the integrated efforts of many response disciplines—government, Emergency Medical Services (EMS), health care facilities, and alternate care facilities—the framework delineates an approach for the delivery of medical care, not just a subset of that care. The committee uses the conceptualization of the framework to discuss the fundamental factors that affect CSC implementation, milestones for CSC planning and implementation, and make a recommendation to improve the planning and implementation of CSC throughout the entire disaster response system in the future.

Conclusions: A systems-based approach to disaster response balances the individual functions and tasks necessary to plan for and implement CSC with the overall structure of an integrated, flexible, and dynamic disaster response.

Learning Areas:
Administration, management, leadership
Clinical medicine applied in public health
Ethics, professional and legal requirements
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
•Describe the basic tenets of developing a multi-tiered systems-based framework for catastrophic response, which is integrated into existing emergency response plans and programs. •Discuss how to enhance tier coordination and consistency with all components (partners) of the emergency response system. •Discuss how Crisis standards of care is an integral part of a greater medical surge planning and how it can be exercised and tested.

Keywords: Disasters, Emergency

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I served as the lead editor for this IOM report, and served as the Vice Chair of the IOM Committee to Establish Standards of Care in a Disaster Situation
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4318.0: Crisis Standards of Care