State and Local Government: Planning for and Implementing Crisis Standards of Care

Background/Purpose: The response mounted to a catastrophic disaster requires governments on all levels—local, state, and federal—to work as an integrated unit to maximize the use of resources and make congruent their policies for the allocation of scarce resources if that becomes necessary. Because a catastrophic disaster is likely to overlap the jurisdictions of these three levels of government, planning for constructive interaction is important to implementing a coherent response. State and local governments can vary widely in their authorities and infrastructure, so a framework to plan for and implement crisis standards of care (CSC) must be general enough to be applicable to all types of state and local governments, but specific enough to provide utility.

Methods: The Institute of Medicine's Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations identifies and addresses the array of relevant state and local government issues through the context of their existing disaster preparedness and response plans and infrastructure. The committee also developed templates to delineate the minimum functions and tasks required to plan for and implement CSC. Each template builds the development of plans for and implementation of CSC into existing emergency response plans and infrastructure.

Results/Outcomes: The committee discusses the interaction between local, state, and the federal government and the implications of those interactions for planning for and implementing CSC.

Conclusions: State and local governments must work within their communities to plan for and implement CSC as a part of their larger disaster response.