Crisis Standards of Care

A Toolkit for Indicators and Triggers

Committee on Crisis Standards of Care: A Toolkit for Indicators and Triggers

Board on Health Sciences Policy

Dan Hanfling, John L. Hick, and Clare Stroud, Editors

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

THE NATIONAL ACADEMIES PRESS     500 Fifth Street, NW     Washington, DC 20001

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. HHSP23337003T between the National Academy of Sciences and the Department of Health and Human Services and Contract No. DTNH22-10-H-00287 between the National Academy of Sciences and the Department of Transportation’s National Highway Traffic Safety Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-28552-0
International Standard Book Number-10: 0-309-28552-6

“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. C. D. Mote, Jr., 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. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

COMMITTEE ON CRISIS STANDARDS OF CARE: A TOOLKIT FOR INDICATORS AND TRIGGERS

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

JOHN L. HICK (Co-Chair), Hennepin County Medical Center, Minneapolis, MN

SARITA CHUNG, Harvard School of Medicine and Boston Children’s Hospital, MA

CAROL CUNNINGHAM, Ohio Department of Public Safety, Columbus

BRIAN FLYNN, Uniformed Services University of the Health Sciences, Bethesda, MD

W. NIM KIDD, Texas Department of Public Safety, Austin

ANN R. KNEBEL, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD

LINDA SCOTT, Michigan Department of Community Health, Lansing

ANTHONY H. SPEIER, State of Louisiana’s Department of Health and Hospitals, Baton Rouge

JOLENE R. WHITNEY, Bureau of Emergency Medical Services and Preparedness, Utah Department of Health, Salt Lake City

IOM Staff

CLARE STROUD, Study Director

BRUCE M. ALTEVOGT, Senior Program Officer

SHEENA M. POSEY NORRIS, Research Associate

DOUGLAS KANOVSKY, Senior Program Assistant

LORA TAYLOR, Financial Associate

DONNA RANDALL, Administrative Assistant

ANDREW M. POPE, Director, Board on Health Sciences Policy

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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:

Hany Abdelaal, VNSNY CHOICE Health Plans
Knox Andress, Louisiana Poison Center
Tracy Buchman, HSS, Inc.
Barbara B. Citarella, RBC Limited
Peggy Connorton, American Health Care Association
Nancy W. Dickey, Texas A&M Health Science Center
Chris Kelenske, Michigan State Police
Arthur L. Kellermann, RAND Corporation
Danita Koehler, Governor’s Alaska Council on Emergency Medical Services
Deborah Levy, Centers for Disease Control and Prevention
Onora Lien, Northwest Healthcare Response Network
Suzet McKinney, Chicago Department of Public Health
Ann Norwood, Center for Biosecurity of UPMC
Sarah Park, Hawaii Department of Health
Nels Sanddal, American College of Surgeons
Leslee Stein-Spencer, National Association of State EMS Officials

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 Mark R. Cullen, Stanford University. 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

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