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Report offers guidelines for crisis health care systems


March 22, 2012

While most areas of the country have systems in place to handle conventional disasters, such as a plane crash or building collapse, the infrastructure and systems to deliver health care during or following catastrophic situations, such as a widespread disease outbreak or a devastating earthquake, are rudimentary at best, says a new report from the Institute of Medicine. 

The report was written by members of the Committee on the Standards of Care for Use in Disaster Situations, including James G. Hodge Jr., the ASU Lincoln Professor of Health Law and Ethics at the Sandra Day O’Connor College of Law. It provides a resource manual to guide health care organizations, public health agencies, first responder teams, and government agencies in delivering care as effectively as possible to the greatest number of people when such disasters occur.

It recommends a systems-based approach to allocating resources and delivering care during crises.  It also provides tools and templates to help different stakeholders involved in disaster planning and response identify their core functions and responsibilities. The report builds on earlier IOM study on developing and implementing crisis standards of care, which specify changes in operations that should apply in situations when usual medical capacity is overwhelmed and resources are scarce.

When catastrophic disasters occur, many stakeholders – hospitals and outpatient clinics, public health departments, the emergency medical system, public safety agencies, and government offices – play distinct, crucial roles. A systems approach emphasizes the importance of coordination and integration across the full spectrum of these stakeholder groups to guarantee a unified, effective response, said the committee that wrote the report.  It ensures all stakeholders are following consistent protocols that take into account legal and ethical considerations when crisis standards of care take effect. 

Only a few communities currently have the level of integration necessary to provide oversight and care for an overwhelming number of victims, the committee noted.  All levels of government should take steps to ensure consistency and coordination of partners involved in emergency responses to disasters and should weave crisis standards of care into their surge capability planning and training exercises. The U.S. departments of Health and Human Services, Homeland Security, Transportation, Defense, and Veterans Affairs should take measures to support this collaboration.

Implementation of crisis standards of care involves a substantial shift in normal health care activities and reallocation of staff, facilities, and resources. To be ready to make the transition quickly and effectively, each organization and agency needs to identify in advance the core functions it must carry out in a crisis and who will be responsible for each task. The report's templates are designed to help stakeholders define these responsibilities as part of developing their crisis plans. The templates will also guide organizations in defining the criteria and process for shifting from conventional to crisis standards of care.

Because public engagement is crucial to the development and use of crisis standards of care, the report also provides a model process and set of tools that health authorities can use to hold public sessions on crisis planning and disaster response. Such sessions will help the public understand why a shift in standards of care could become necessary and how these standards will be applied as well as changes in legal and regulatory authorities, the committee said.

“When a truly catastrophic event occurs, the nation's health system will be under enormous stress,” noted committee chair Lawrence O. Gostin, associate dean and Linda D. and Timothy J. O'Neill Professor of Global Health Law, Georgetown University Law Center. “Health professionals can bring the best care to the most people by using a systems approach that involves thoughtful coordination among all stakeholders and good planning and coordination among all levels of government. This report provides an overarching framework for action in such events and provides detailed standards for each responsible group.”

“Crisis standards of care planning and implementation will significantly increase the likelihood of saved lives and reduced suffering when catastrophic disasters occur,” said vice chair Dan Hanfling, emergency physician and special adviser on emergency preparedness and disaster response, Inova Health System, Falls Church, Va., and clinical professor, department of emergency medicine, George Washington University.

The report was sponsored by the U.S. Department of Health and Human Services, U.S. Department of Transportation and U.S. Department of Veterans Affairs. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The Institute of Medicine, National Academy of Sciences, National Academy of Engineering and National Research Council together make up the independent, nonprofit National Academies

To download a copy of the full report, click here

Hodge is Director of the Public Health Law Network – Western Region, housed at the College of Law, Director of the Public Health Law and Policy Program, and a Faculty Fellow in the Center for Law, Science & Innovation. He also is an affiliate faculty member in the ASU School of Human Evolution & Social Change, the School of Public Affairs and the Department of Biomedical Informatics. Through scholarship, teaching, and applied projects, Hodge delves into multiple areas of health law, public health law, global health law, ethics and human rights. He teaches Health Law, Ethics, and Policy, Public Health Law and Ethics, and Global Health Law and Policy.