Rapid Expert Consultation on Crisis Standards of Care for the COVID-19 Pandemic (March 28, 2020) (2020) / Chapter Skim
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Rapid Expert Consultation
Rapid Expert Consultation
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Kadlec: Attached please find a rapid expert consultation that was prepared by the co-conveners of the Crisis Standards of Care working group, John Hick and Dan Hanfling, with input from others listed in the attachment, and conducted under the auspices of the National Academies of Sciences, Engineering, and Medicine's Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats. Building on the previous decade of National Academies reports, the aim of this rapid expert consultation is to articulate the guiding principles, key elements, and core messages that undergird Crisis Standards of Care decision making at all levels.
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Chair Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats This rapid expert consultation responds to your March 25 request to provide a rationale for the implementation of crisis standards of care (CSC) in response to the COVID-19 outbreak.
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Legal Considerations • Health care workers who must make difficult decisions implementing CSC must have adequate guidance and legal protections. • Under disaster conditions, adherence to core constitutional principles remains a constant, but other statutory or regulatory provisions can be altered as necessary in real time.
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THE CONTINUUM OF CARE Standards of care fall along a continuum of three levels, reflecting the incremental surge in demand relative to available health care resources: • Conventional care is everyday health care services. • Contingency care arises when demand for medical staff, equipment, or pharmaceuticals begins to exceed supply.
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To this end, health care leaders must be proactive, honest, transparent, and accountable when communicating the state of their institutions and the system as a whole. Given the resources available at the start of the crisis and expected during the immediate period, demand for health care services, especially in critical care, will soon outstrip health care providers' ability to deliver usual care in many communities, as has already occurred in several metropolitan areas.
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This enables caregivers to better fulfill their ethical obligations to individual patients, while other decision-making processes ensure care provides the greatest good for the greatest number. Governments at all levels, institutions, and frontline caregivers should recognize that these decisions are difficult and inherently involve ethical concerns.
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. Applying this overarching principle requires wise stewardship of medical resources, so that health care workers can help as many patients as possible.
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2 One of those recommendations was to "enable specific legal/regulatory powers and protections for health care providers in the necessary tasks of allocating and using scarce medical resources and implementing alternate care facilities" in the response to such events. The Letter Report also emphasized that CSC should be "formally declared by a state government" in recognition that crisis care operations "will be in place for a sustained period of time." Building on this work, the IOM in 2012 issued a report 3 articulating a systems framework for catastrophic disaster planning and response, highlighting specific steps that key stakeholders -- hospitals and health systems, public health and public safety agencies, emergency medical services, and providers of outpatient medical services -- would need to take to prepare for health care delivery under crisis conditions.
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The working group for this document included the following individuals: Donald Berwick, Institute for Healthcare Improvement; Richard Besser, Robert Wood Johnson Foundation; Carlos del Rio, Emory Vaccine Center; James Hodge, Arizona State University; Kent Kester, Sanofi Pasteur; Jennifer Nuzzo, Johns Hopkins Bloomberg School of Public Health; Tara O'Toole, In-Q-Tel; Richard Serino, Harvard T.H. Chan School of Public Health; Beth Weaver, RESOLVE; and Matthew Wynia, University of Colorado Center for Bioethics and Humanities.
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