Guidance for Establishing Standards of Care for Use in Disaster Situations

Type: Consensus Study
Topics: Health Care Workforce, Health Services, Coverage, and Access, Public Health, Quality and Patient Safety
Board: Board on Health Sciences Policy

Activity Description

In response to a request from the HHS Office of the Assistant Secretary of Preparedness and Response, the Institute of Medicine The IOM convened a committee of experts on crisis standards of care (the committee) and published “Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report” in September 2009 as the primary deliverable for Phase 1 of the Project entitled “Medical Standards of Care for Use in Disaster Situations”.  The project activities that informed the Letter Report included the expert opinion of the committee, a public meeting with expert presentations, and a white paper that provided background information for the committee summarizing the most relevant information available regarding standards of care in a disaster, particularly as applicable to a potential 2009 influenza pandemic.

The committee is now engaged in a second phase of this project that will update the preliminary guidance developed in phase 1. Specifically the committee will:

-Identify metrics to assess the development of crisis standards of care protocols by state and local governments, that include elements such as dissemination, development, and implementation,

-Review the impact of its 2009 letter report including progress made by state and local governments and health care organizations in establishing crisis standards of care guidance.

-Develop templates for states, emergency medical services (EMS) systems, hospitals and individual clinicians to guide decision making when implementing crisis standards of care that can be easily read, understood and executed during an incident. These templates will:

  • Address the inclusion of all critical components of the emergency response and health care system necessary to plan for and respond to crisis standards of care situations.
  • Examine the specific process of declaring a shift to crisis standards of care, focusing on roles and responsibilities of decision-makers from the local to the national level, including.
  • The roles and responsibilities of public and private health care systems (e.g., the responsibility of a local VA Medical Center Director vs. regional Veterans Integrated Service Network (VISN) Director, authority and the role of military treatment facilities (MTFs), local, regional and national healthcare system clinical and administrative leadership in private health care systems;
  • The role of state EMS authorities in providing medical oversight and coordination of a shift to crisis response for a state's EMS system including 9-1-1 dispatch and pre-hospital emergency medical care.
  • Identify clinical and administrative indicators that govern the transition from conventional surge response and conventional standards of care to crisis surge response and crisis standards of care, and the return to conventional standards of care. Reference and highlight existing clinical protocols and related governance structures that need to be in place to facilitate decision making under crisis standards.
  • These indicators, clinical protocols, and governance structures should be applicable to specific scenarios of both gradual onset as well as no notice incidents, and should pertain to the pre-hospital, community and hospital settings.
  • Define terms and provide consistent language (e.g. definitions, situational markers) for communicating across jurisdictions and levels of government the status of healthcare systems related to crisis standards of care
  • In addition the committee will develop templates that can be used by state and local governments to guide community engagement. These would be based on a series of focus groups utilizing scenario-based engagement strategies to identify what shifts are tolerable from the community point of view, including the physician, active duty military, and veteran's communities.

Phase 2 of this project will result in a report that is expected to be released in late 2011.

As of March 2016, the Health and Medicine Division continues the consensus studies and convening activities previously undertaken by the Institute of Medicine (IOM).

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