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Crisis Standards of Care Implementation at the State Level in the United States

  • Colton Margus (a1), Ritu R. Sarin (a2) (a3), Michael Molloy (a2) (a3) (a4) and Gregory R. Ciottone (a2) (a3)

Abstract

Introduction:

In 2009, the Institute of Medicine published guidelines for implementation of Crisis Standards of Care (CSC) at the state level in the United States (US). Based in part on the then concern for H1N1 pandemic, there was a recognized need for additional planning at the state level to maintain health system preparedness and conventional care standards when available resources become scarce. Despite the availability of this framework, in the years since and despite repeated large-scale domestic events, implementation remains mixed.

Problem:

Coronavirus disease 2019 (COVID-19) rejuvenates concern for how health systems can maintain quality care when faced with unrelenting burden. This study seeks to outline which states in the US have developed CSC and which areas of care have thus far been addressed.

Methods:

An online search was conducted for all 50 states in 2015 and again in 2020. For states without CSC plans online, state officials were contacted by email and phone. Public protocols were reviewed to assess for operational implementation capabilities, specifically highlighting guidance on ventilator use, burn management, sequential organ failure assessment (SOFA) score, pediatric standards, and reliance on influenza planning.

Results:

Thirty-six states in the US were actively developing (17) or had already developed (19) official CSC guidance. Fourteen states had no publicly acknowledged effort. Eleven of the 17 public plans had updated within five years, with a majority addressing ventilator usage (16/17), influenza planning (14/17), and pediatric care (15/17), but substantially fewer addressing care for burn patients (9/17).

Conclusion:

Many states lacked publicly available guidance on maintaining standards of care during disasters, and many states with specific care guidelines had not sufficiently addressed the full spectrum of hazard to which their health care systems remain vulnerable.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Colton Margus, MD, 266 Indian Avenue, Middletown, Rhode Island02842USA, E-mail: cmargus@bidmc.harvard.edu

References

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1.Hick, JL, Hanfling, D, Cantrill, SV. Allocating scarce resources in disasters: emergency department principles. Ann Emerg Med. 2012;59(3):177-187.
2.Ayer, L, Engel, C, Parker, A, Seelam, R, Ramchand, R. Behavioral health of Gulf Coast residents 6 years after the Deepwater Horizon oil spill: the role of trauma history. Disaster Med Public Health Prep. 2019;13(3):497-503.
3.Metzger, K, Akram, H, Feldt, B, et al.Epidemiologic investigation of injuries associated with the 2013 fertilizer plant explosion in West, Texas. Disaster Med Public Health Prep. 2016;10(4):583-590.
4.Schnall, AH, Hanchey, A, Nakata, N, et al.Disaster-related shelter surveillance during the Hurricane Harvey response - Texas 2017. Disaster Med Public Health Prep. 2019;14(1):1-7.
5.Stephens, W, Wilt, GE, Lehnert, EA, Molinari, NM, LeBlanc, TT. A spatial and temporal investigation of medical surge in Dallas-Fort Worth during Hurricane Harvey, Texas 2017. Disaster Med Public Health Prep. 2020;14(1):1-8.
6.Petrun Sayers, EL, Parker, AM, Ramchand, R, Finucane, ML, Parks, V, Seelam, R. Reaching vulnerable populations in the disaster-prone US Gulf Coast: communicating across the crisis lifecycle. J Emerg Manag. 2019;17(4):271-286.
7.Reardon, S. Raging wildfires send scientists scrambling to study health effects. Nature. 2018;561(7722):157-158.
8.Houston, JB, Spialek, ML, Stevens, J, First, J, Mieseler, VL, Pfefferbaum, B. 2011 Joplin, Missouri tornado experience, mental health reactions, and service utilization: cross-sectional assessments at approximately 6 months and 2.5 years post-event. PLoS Curr. 2015;7.
9.Hick, JL, Hanfling, D, Wynia, MK, Pavia, AT. Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2. Washington, DC USA: National Academy of Medicine; 2020. https://nam.edu/duty-to-plan-health-care-crisis-standards-of-care-and-novel-coronavirus-sars-cov-2/. Accessed March 5, 2020.
10.Droogers, M, Ciotti, M, Kreidl, P, et al.European pandemic influenza preparedness planning: a review of national plans, July 2016. Disaster Med Public Health Prep. 2019;13(3):582-592.
11.Kwan-Gett, TS, Baer, A, Duchin, JS. Spring 2009 H1N1 influenza outbreak in King County, Washington. Disaster Med Public Health Prep. 2009;3(Suppl 2):S109-116.
12.Institute of Medicine (US) Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations. Altevogt, BM, Stroud, C, Hanson, SL, Hanfling, D, Gostin, LO, (eds). Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. Washington, DC USA: National Academies Press; 2009.
13.Committee on Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations; Institute of Medicine. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Washington, DC USA: National Academies Press; 2012.
14.Sarin, RR, Molloy, MS, Ciottone, GR. Analysis of state-level guidance on the implementation of crisis standards of care in the United States. Prehosp Disaster Med. 2015;30(S1):s154.
15.A bill to amend the Public Health Service Act with respect to public health security and all-hazards preparedness and response, and for other purposes: ‘Pandemic and All-Hazards Preparedness Act.’ December 19, 2006. In: Public Law No: 109-417.
16.Bartlett, JG, Borio, L. Healthcare epidemiology: the current status of planning for pandemic influenza and implications for health care planning in the United States. Clin Infect Dis. 2008;46(6):919-925.
17.Powell, T, Christ, KC, Birkhead, GS. Allocation of ventilators in a public health disaster. Disaster Med Public Health Prep. 2008;2(1):20-26.
18.Devereaux, AV, Dichter, JR, Christian, MD, et al. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, Illinois [USA]. Chest. 2008;133(5 Suppl):51S-66S.
19.Eastman, N, Philips, B, Rhodes, A. Triaging for adult critical care in the event of overwhelming need. Intensive Care Med. 2010;36(6):1076-1082.
20.Vincent, JL, Moreno, R, Takala, J, et al.The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707-710.
21.Adeniji, KA, Cusack, R. The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis. Critical Care. 2011;15:R39.
22.Dries, D, Reed, MJ, Kissoon, N, et al.Special populations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146(4Suppl):e75S-86S.
23.Savoia, E, Lin, L, Bernard, D, Klein, N, James, LP, Guicciardi, S. Public health system research in public health emergency preparedness in the United States (2009-2015): actionable knowledge base. Am J Public Health. 2017;107(S2):e1-e6.
24.Daniel, M. Bedside resource stewardship in disasters: a provider’s dilemma practicing in an ethical gap. J Clin Ethics. 2012;23(4):331-335.
25.Leider, JP, DeBruin, D, Reynolds, N, Koch, A, Seaberg, J. Ethical guidance for disaster response, specifically around crisis standards of care: a systematic review. Am J Public Health. 2017;107(9):e1-e9.
26.Hodge, JG, Hanfling, D, Powell, TP. Practical, ethical, and legal challenges underlying crisis standards of care. J Law Med Ethics. 2013;41(Suppl 1):50-55.
27.Schultz, CH, Annas, GJ. Altering the standard of care in disasters--unnecessary and dangerous. Ann Emerg Med. 2012;59(3):191-195.
28.Hanfling, D, Hick, JL, Cantrill, SV. Understanding the role for crisis standards of care. Ann Emerg Med. 2012;60(5):669-670; author reply 670-671.
29.Kipnis, K. Disasters, catastrophes, and worse: a scalar taxonomy. Camb Q Healthc Ethics. 2013;22(3):297-307.
30.Sauer, LM, McCarthy, ML, Knebel, A, Brewster, P. Major influences on hospital emergency management and disaster preparedness. Disaster Med Public Health Prep. 2009;3(2Suppl):S68-73.
31.WHO Global Team. Maintaining essential health services: operational guidance for the COVID-19 context. https://www.who.int/publications-detail/covid-19-operational-guidance-for-maintaining-essential-health-services-during-an-outbreak. Published March 25, 2020. Updated June 1, 2020. Accessed June 3, 2020.
32.Adalja, AA, Toner, E, Inglesby, TV. Priorities for the US health community responding to COVID-19. JAMA. 2020. Epub ahead of print.
33.Timbie, JW, Ringel, JS, Fox, S, et al.Allocation of scarce resources during mass casualty events. Evid Rep Technol Assess (Full Rep). 2012;(207):1-305.

Keywords

Crisis Standards of Care Implementation at the State Level in the United States

  • Colton Margus (a1), Ritu R. Sarin (a2) (a3), Michael Molloy (a2) (a3) (a4) and Gregory R. Ciottone (a2) (a3)

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