Crisis Standards of Care: A Toolkit for Indicators and Triggers

Type: Consensus Study
Topics: Global Health, Biomedical and Health Research, Public Health
Board: Board on Health Sciences Policy

Activity Description

Devastating catastrophes that took place in 2011 and 2012—including a tornado that devastated Joplin, Missouri; earthquakes that rocked Christchurch, New Zealand; an earthquake that struck Japan and triggered a powerful tsunami; and Hurricane Sandy—underscored how quickly and completely health systems can be overwhelmed. Disasters, whether they occur suddenly and are unexpected or are caused by slow, sustained public health emergencies, can stress health care systems to the breaking point and disrupt delivery of vital medical services.

In the early stages of the 2009 H1N1 pandemic, the Assistant Secretary for Preparedness and Response (ASPR) in the Department of Health and Human Services asked the IOM to form a committee to develop guidance that health officials could use to establish and implement standards of care during disasters. In its report, the committee defined “crisis standards of care” (CSC) as a state of being that indicates a substantial change in health care operations and the level of care that can delivered in a public health emergency, justified by specific circumstances. Medical care delivered during disasters shifts beyond focusing on individuals to promoting the thoughtful stewardship of limited resources intended to result in the best possible health outcomes for the population as a whole. 

In 2010, ASPR, the Department of Veterans Affairs (VA), and the National Highway Transportation Safety Administration (NHTSA) asked the IOM expert committee to reconvene to provide concepts and guidance to help state and local officials apply the CSC framework the committee created earlier. In its 2012 report, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response, the committee examined the effect of its 2009 report, and developed underlying principles, concepts, planning milestones, and templates to guide the efforts of professionals and organizations responsible for CSC planning and implementation.

In the fall of 2012, HHS, VA, and NHTSA asked the IOM to convene another expert committee to build on previous IOM work by developing a conversation toolkit that will help stakeholders identify indicators and triggers that may govern their health system’s transition across the continuum of care, from conventional standards of care to contingency surge response and standards of care to crisis surge response and standards of care, and back to conventional standards of care.

      Indicator: Measurement or predictor that is used to recognize surge capacity and capability problems within the health care system, suggesting that crisis standards of care may become necessary and requiring further analysis or system action to prevent overload.

      Trigger: Evidence that austere conditions prevail so that crisis standards of care will be required. (Definitions from IOM, 2012)

This committee will meet in January and March and will release its report in the summer of 2013.


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