1

Introduction

Crisis standards of care (CSC) planning began at the national level in 2009 during the H1N1 pandemic. Efforts included the publication of an Institute of Medicine Letter Report underlining the importance of having more guidance for health care institutions and providers. The dramatic experiences during Hurricane Katrina in New Orleans in 2005 were followed by significant concerns about the resiliency of our health care system when the 2009/2010 H1N1 pandemic arose. It quickly became clear that leaving some of these critical life-or-death decisions to chance or to be made by those under stress at the bedside, without protections or guidance, was no longer an option. From that point, several more consensus reports emerged through the National Academies of Sciences, Engineering, and Medicine, as well as ad hoc workshops on community engagement and lessons learned after 10 years of conversations, and this type of specialized planning matured around the country. While the focus and intensity of CSC planning by government officials and public health and health care leaders has ebbed and flowed over the years, numerous points throughout the COVID-19 pandemic have demonstrated the necessity of this type of crisis planning. Given the rise in firsthand experiences with allocation of scarce resources and questions of balancing patients adequately across a region during extended emergencies, the Forum on Medical and Public Health

Preparedness for Disasters and Emergencies identified the need to pull some of these lessons together to inform current and future efforts (see Box 1-1).¹

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¹ The planning committee’s role was limited to planning the workshop, and this Proceedings of a Workshop has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

ORGANIZATION OF THE WORKSHOP

This workshop series was organized and held virtually as five webinars throughout October and November 2021.² The first workshop introduced the concept of CSC and focused on reflections and opportunities for the future. The second workshop recounted ongoing lessons from the COVID-19 pandemic in terms of staffing and workforce needs. The third

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²https://www.nationalacademies.org/our-work/evolving-crisis-standards-of-care-and-lessons-learned-a-workshop-series (accessed January 5, 2022).

workshop examined planning and the implementation of CSC plans at various levels. The fourth highlighted the legal, ethical, and equity considerations of CSC planning and what has been learned from the COVID-19 pandemic. The fifth and final workshop summarized discussion points across the previous meetings and offered key lessons in the different lanes of planning and highlighted opportunities for change.

ORGANIZATION OF THE PROCEEDINGS

This proceedings is organized into six chapters aligned with the individual webinars. Following this introductory chapter, Chapter 2 focuses on the initial CSC framework and looks back on its implementation in various scenarios. Chapter 3 highlights the staffing considerations and future trends that can inform planning and implementation. Chapter 4 covers CSC planning and implementation with examples from several jurisdictions. Chapter 5 reviews the lessons learned from COVID-19 with respect to legal, ethical, and equity considerations. As the final chapter, Chapter 6 brings together several key lessons and suggestions from various speakers to inform future planning and to identify areas with the greatest potential for positive change.