Evolving Crisis Standards
of Care and Ongoing
Lessons from COVID-19
_____
Megan Snair, Aurelia Attal-Juncqua,
and Scott Wollek, Rapporteurs
Forum on Medical and Public Health
Preparedness for Disasters and
Emergencies
Board on Health Sciences Policy
Health and Medicine Division
Proceedings of a Workshop Series
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and the Administration for Children and Families (contract no. HHS P233201400020B/75P00120F37103), the Assistant Secretary for Preparedness and Response (contract no. 75A50121P00089), the Centers for Disease Control and Prevention (contract no. 200-2011-38807/75D30120F00093), the Department of Homeland Security (contract no. HSHQDC-17-A-B0001/70RHAD18FR0000003), the Food and Drug Administration (contract no. 75F40120P00067), the National Highway Traffic Safety Administration (contract no. 693JJ921P000049), and the National Institutes of Health (contract no. HHSN263201800029I/HHSN26300026). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-68879-6
International Standard Book Number-10: 0-309-68879-5
Digital Object Identifier: https://doi.org/10.17226/26573
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Evolving crisis standards of care and ongoing lessons from COVID-19: Proceedings of a workshop series. Washington, DC: The National Academies Press. https://doi.org/10.17226/26573.
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PLANNING COMMITTEE ON EVOLVING CRISIS STANDARDS OF CARE AND LESSONS LEARNED1
ERIC TONER (Chair), Senior Scholar, Johns Hopkins University
ASHA DEVEREAUX, Senior Medical Officer, Sharp Coronado Hospital
MEGAN JEHN, Associate Professor, Arizona State University
ANUJ MEHTA, Pulmonary and critical care physician, Denver Health and Hospital Authority
GREGG S. MEYER, President, Community Division, and Executive Vice President, Value-Based Care, Mass General Brigham
MONICA E. PEEK, Associate Professor of Medicine, University of Chicago
JENNIFER PIATT, Deputy Director, Network for Public Health Law–Western Region Office
ERIN SERINO, Deputy Chief of Staff, Boston Emergency Medical Services
TENER GOODWIN VEENEMA, Contributing Scholar, Professor of Nursing, Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health
MICHAEL WARGO, Vice President and Chief, Enterprise Preparedness and Emergency Operations, HCA Healthcare
SHANDIIN WOOD, Health Systems Epidemiologist and Tribal Liaison, New Mexico Department of Health
MATTHEW WYNIA, Director, University of Colorado Center for Bioethics and Humanities
Health and Medicine Division Staff
SCOTT WOLLEK, Forum Director
LISA BROWN, Senior Program Officer
AURELIA ATTAL-JUNCQUA, Program Officer
MICHAEL BERRIOS, Research Associate
KIMBERLY SUTTON, Senior Program Assistant
ANDREW M. POPE, Director, Board on Health Sciences Policy
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
Consultants
LAURA RUNNELS, LAR Consulting
KELLY SCHENK, LAR Consulting
MEGAN SNAIR, SGNL Solutions
JUSTIN SNAIR, SGNL Solutions
Reviewers
This Proceedings of a Workshop Series was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
JAMES G. HODGE, Peter Kiewit Foundation Professor of Law, Director of the Center for Public Health Law and Policy, Sandra Day O’Connor College of Law, Arizona State University
JEFFREY UPPERMAN, Professor and Chair, Department of Pediatric Surgery, Vanderbilt University
MATTHEW WATSON, Senior Analyst, Johns Hopkins Center for Health Security; Senior Research Associate Johns Hopkins Bloomberg School of Public Health
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by ROBERTA LAVIN, FAAN Professor and Ph.D. Program Director at the University of New Mexico, College of Nursing. She was responsible for making certain that an independent
examination of this proceedings was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
Contents
Organization of the Proceedings
2 REFLECTIONS, INFLECTIONS, AND THE FUTURE
The First 10 Years of Crisis Standards of Care
Three Scenarios of Crisis Standards of Care
Looking Back at Firsthand Experiences and Lessons Learned
3 CONSIDERATIONS FOR STAFFING, EFFECTS ON THE WORKFORCE, AND FUTURE TRENDS
Effects of COVID-19 on the Workforce
Promising Staffing Strategies and Future Directions
Reflections on the Nursing Crisis and Future Directions
4 CRISIS STANDARDS OF CARE: FROM PLANS TO REALITY
Abbreviations and Acronyms
ASPR | Office of the Assistant Secretary for Preparedness and Response |
CDPHE | Colorado Department of Public Health and Environment |
CSC | crisis standards of care |
EMS | emergency medical services |
HHS | U.S. Department of Health and Human Services |
ICU | intensive care unit |
MRC | Medical Reserve Corps |
OCR | Office for Civil Rights |
PPE | personal protective equipment |
SOFA | sequential organ failure assessment |
SVI | Social Vulnerability Index |
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