Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response
Devastating catastrophes that took place in 2011—including a tornado that devastated Joplin, Missouri, earthquakes that rocked Christchurch, New Zealand, and an earthquake that struck Japan and triggered a powerful tsunami— underscore 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.
At the height of the first global influenza pandemic in a generation, the Department of Health and Human Services (HHS) asked the Institute of Medicine (IOM) to convene a committee of experts. During the first phase, finished in 2009, the IOM committee developed guidance that health officials could use to establish and implement standards of care during disasters.
In that 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 be 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. CSC is one critical component of disaster planning and is necessary to equitably allocate scarce resources, the committee concluded.
In 2010, HHS, the Department of Veterans Affairs (VA), and the National Highway Traffic Safety Administration 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 report, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response, the committee examines the effect of its 2009 report, and develops important templates to guide the efforts of professionals and organizations responsible for CSC planning and implementation.
The committee finds that integrated planning for coordinated response by state and local governments, emergency medical services (EMS), health care organizations, and health care providers in the community is critical to successfully responding to disasters.
At the core of a well-functioning CSC system are fundamental ethical values to ensure that all providers act with compassion and justice. Having a responsive legal and regulatory environment is also important. An effective and fair legal system encourages all health professionals and volunteers to perform their functions well while also maximizing health resources and protecting patients from unnecessary harm.
Delivering the Best Care Possible
The committee strongly recommends weaving CSC into the broader context of disaster planning— what it considers a “systems” approach. The entire emergency response system—independent actors who work alone as well as in tandem within a coherent, integrated group—must adopt this type of approach to deliver the best care possible to the largest number of patients.
The committee’s multi-tiered, systems-based framework for catastrophic response can be integrated into existing emergency response plans and programs.
For CSC planning to be implemented successfully, it must be embraced by the full spectrum of disciplines that participate in an emergency response, and not simply adopt a narrow focus on the issue of health care delivery. Each key actor—emergency management, public safety, public health, EMS, healthcare organizations, and community-based health practitioners—greatly influences the success or failure of the system as a whole to provide care during catastrophes.