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.
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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
Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
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Copyright 2012 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
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Suggested citation: IOM (Institute of Medicine). 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Washington, DC: The National Academies Press.
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
EDWARD J. GABRIEL,* The Walt Disney Company, Burbank, CA
JOHN L. HICK, Hennepin County Medical Center, Minneapolis, MN
JAMES G. HODGE, JR., Center for the Study of Law, Science, and Technology, Arizona State University, Tempe
DONNA E. LEVIN, Massachusetts Department of Public Health, Boston
MARIANNE MATZO, University of Oklahoma Health Sciences Center, Oklahoma City
CHERYL A. PETERSON, American Nurses Association, Silver Spring, MD
TIA POWELL, Montefiore-Einstein Center for Bioethics, Albert Einstein College of Medicine, New York, NY
MERRITT SCHREIBER, University of California, Irvine, School of Medicine
UMAIR A. SHAH, Harris County Public Health and Environmental Services, Houston, TX
JOLENE R. WHITNEY, Bureau of Emergency Medical Services (EMS) and Preparedness, Utah Department of Health, Salt Lake City
Study Staff
BRUCE M. ALTEVOGT, Study Director
ANDREW M. POPE, Director, Board on Health Sciences Policy
CLARE STROUD, Program Officer
LORA TAYLOR, Senior Project Assistant (until January 2012)
ELIZABETH THOMAS, Senior Project Assistant (since February 2012)
KRISTIN VISWANATHAN, Research Associate
RONA BRIER, Editor
BARBARA FAIN, Consultant for Public Engagement
_________________
* Resigned from the committee October 2011.
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.
Contents
VOLUME 1: INTRODUCTION AND CSC FRAMEWORK
Phase Two: Study Goals and Methods
2009 Letter Report: Key Elements and Recommendations
Impact of the 2009 Letter Report
2 Catastrophic Disaster Response: Creating a Framework for Medical Care Delivery
Conceptualizing a Systems Approach to Disaster Response
Fundamental Factors That Influence the Implementation of Crisis Standards of Care
Guidance for Disaster Response Stakeholders
Milestones for Crisis Standards of Care Planning and Implementation
Implementation of the Disaster Response Framework
Medical and Legal Standards of Care
The Changing Legal Environment in Declared Emergencies
| AHRQ | Agency for Healthcare Research and Quality |
| AMA | American Medical Association |
| APHA | American Public Health Association |
| ASPR | Assistant Secretary for Preparedness and Response |
| ASTHO | Association of State and Territorial Health Officials |
| CDC | Centers for Disease Control and Prevention |
| CONOPS | concept of operations |
| CSC | crisis standards of care |
| DHS | Department of Homeland Security |
| DOD | Department of Defense |
| EMAC | Emergency Management Assistance Compact |
| EMS | emergency medical services |
| EMTALA | Emergency Medical Treatment and Active Labor Act |
| EOC | emergency operations center |
| EUA | emergency use authorization |
| FDA | Food and Drug Administration |
| HCC | health care coalition |
| HCF | health care facility |
| HCPHES | Harris County Public Health and Environmental Services |
| HHS | Department of Health and Human Services |
| HICS | hospital incident command system |
| HIPAA | Health Insurance Portability and Accountability Act |
| HPP | Hospital Preparedness Program |
| ICU | intensive care unit |
| IOM | Institute of Medicine |
| MAC | medical advisory committee |
| MCE | mass casualty event |
| MEMS | Modular Emergency Medical System |
| MIMAL | Model Intrastate Mutual Aid Legislation |
| MOU | memorandum of understanding |
| MRC | Medical Reserve Corps |
| MSCC | Medical Surge Capacity and Capability |
| MSEHPA | Model State Emergency Health Powers Act |
| NACCHO | National Association of County and City Health Officials |
| NCCUSL | National Conference of Commissioners on Uniform State Laws |
| NDMS | National Disaster Medical System |
| NIMS | National Incident Management System |
| NLE | National Level Exercise |
| NRF | National Response Framework |
| NSAID | nonsteroidal anti-inflammatory drug |
| OSHA | Occupational Safety and Health Administration |
| PACU | postanesthesia care unit |
| PC | palliative care |
| PHEP | Public Health Emergency Preparedness |
| PPE | personal protective equipment |
| PREP | Public Readiness and Emergency Preparedness |
| PTSD | posttraumatic stress disorder |
| RDMAC | regional disaster medical advisory committee |
| RMCC | regional medical coordination center |
| SARS | severe acute respiratory syndrome |
| SDMAC | state disaster medical advisory committee |
| SNS | Strategic National Stockpile |
| SOFA | Sequential Organ Failure Assessment |
| UEVHPA | Uniform Emergency Volunteer Health Practitioners Act |
| VA | Department of Veterans Affairs |
| VHP | volunteer health practitioner |
| VPA | Volunteer Protection Act |
