Crisis Standards of Care

A Systems Framework for Catastrophic Disaster Response

Volume 1: Introduction and CSC Framework

Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations

Board on Health Sciences Policy

Dan Hanfling, Bruce M. Altevogt, Kristin Viswanathan, and Lawrence O. Gostin, Editors

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. HHSP23320042509XI between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

Crisis standards of care : a systems framework for catastrophic disaster
response / Committee on Guidance for Establishing Standards of Care for Use in
Disaster Situations, Board on Health Sciences Policy ; Dan Hanfling … [et al.], editors.

    p. ; cm.

Includes bibliographical references.

ISBN 978-0-309-25346-8 (hardcover) — ISBN 978-0-309-25347-5 (pdf) I. Hanfling, Dan.

II. Institute of Medicine (U.S.). Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations.

[DNLM: 1. Disaster Medicine—standards—United States. 2. Emergency Medical Services—standards—United States. 3. Emergency Treatment—standards—United States. WA 295]

363.34—dc23

2012016602

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”

—Goethe

INSTITITE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

COMMITTEE ON GUIDANCE FOR ESTABLISHING STANDARDS OF CARE FOR USE IN DISASTER SITUATIONS

LAWRENCE O. GOSTIN(Chair), O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC

DAN HANFLING (Vice-Chair), Inova Health System, Falls Church, VA

DAMON T. ARNOLD, Illinois Department of Public Health, Chicago (retired)

STEPHEN V. CANTRILL, Denver Health Medical Center, CO

BROOKE COURTNEY, Food and Drug Administration, Bethesda, MD

ASHA DEVEREAUX, California Thoracic Society, San Francisco, CA

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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Richard Alcorta, Maryland Institute for Emergency Medical Services Systems

Knox Andress, Louisiana Poison Center

Connie Boatright-Royster, MESH Coalition

Susan Cooper, Tennessee Department of Health

Lance Gable, Wayne State University Center for Law and the Public’s Health

Carol Jacobson, Ohio Hospital Association

Amy Kaji, Harbor-UCLA Medical Center

Jon Krohmer, Department of Homeland Security

Onora Lien, King County Healthcare Coalition

Suzet McKinney, The Tauri Group

Peter Pons, Denver Health Medical Center

Clifford Rees, University of New Mexico School of Law

Linda Scott, Michigan Department of Community Health

Robert Ursano, Uniformed Services University School of Medicine

Lann Wilder, San Francisco General Hospital and Trauma Center

Matthew Wynia, American Medical Association

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before

its release. The review of this report was overseen by Dr. Georges Benjamin, American Public Health Association. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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