Crisis Standards of Care Ten Years of Successes and Challenges: Proceedings of a Workshop (2021) / Chapter Skim
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4 Crisis Standards of Care Application Across Sectors
4 Crisis Standards of Care Application Across Sectors
Pages 21-32
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From page 21... ...
Case studies are discussed from the federal and state levels, as well as from the clinical and supply-chain settings, to highlight the diversity in issues that need to be considered in this multisectoral effort. FEDERAL PLANNING AND RESPONSE Speakers discussed CSC examples from the planning, response, and recovery phases across a variety of disaster types over the past several years.
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From page 22... ...
Similarly, considerations regarding dual and triple antimicrobial therapy and antitoxin therapy for systemic anthrax for conventional care settings as well as scenarios with potential shortages were presented. These do not just apply during catastrophic events, Pillai noted, but are used on smaller problems, such as botulism outbreaks, which can still stretch health care and public health resources.
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From page 23... ...
To attempt this, they started to convene a committee, and fully engaged Haitian clinicians about who should be flown to the United States to receive care. Through this process, they learned the top reasons people were being flown back to the United States, and found they could partially address this problem by, instead, flying the right people to Haiti to fix devices so scans could be done in the country; they flew neurosurgeons and plastic surgeons to Haiti to conduct the needed care.
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From page 24... ...
However, some hospitals had not yet used their emergency supply, and did not want to require clinicians to conserve oxygen when their individual system had not reached a crisis threshold demanding altered standards of care. He emphasized that this is a critical point -- that CSC is driven by a globally dependent health care supply chain, but many people visualize the standards from an individual hospital-level perspective.
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From page 25... ...
She showed the state's timeline of activities since 2001, demonstrating the long-term effort this type of planning demands. She said they started out reviewing the current legal environment, then moved toward establishing an advisory team, which produced patient care strategies for scarce resource situations.
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From page 26... ...
He also said that future applications should include translating the state CSC plan to the local levels and continuing to develop state fatality management response coordination and responsibilities. CLINICAL SETTINGS Colleen Ryan, professor of surgery at the Harvard Medical School, provided insight into the application of triage tables related to a masscasualty event that results in overwhelming numbers of burn patients.
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From page 27... ...
The burn SME activated the ABA national disaster system response, which triggered a national (and Canadian) available burn bed count, deployment of media packages that had bystander care, just-intime education, notifications to supply chains, and -- importantly for this discussion -- actual selection of severity matched triage tables and matching of patients based on altered standards of care (Kearns et al., 2020)
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From page 28... ...
Fifteen fictional patients were triaged to comfort care, and 78 were triaged to care outside of burn centers. This was the first instance of actionable triage table deployment in a large-scale functional exercise, Ryan noted.
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From page 29... ...
For future applications of CSC, Louissant suggested taking a more proactive posture during hurricane season and highlighted the different considerations for wind, versus water, events. She added, there is also a need in this space to continue identifying adequate substitutes and developing critical product lists.
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From page 30... ...
One participant said that after doing a gap analysis of health care on the island, he found water and Internet access to be clear deficits for health care, in addition to power and transportation. Following electronic health record requirements, most of that information is stored in "the cloud," and even 6 weeks after the storm, hospitals still did not have Internet access.
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From page 31... ...
How can we maintain a key focus on this issue of equity, she asked? Pillai responded that in terms of the anthrax clinical guidance, CDC sought to highlight populations that could be more vulnerable than others in an anthrax masscasualty event, thinking strategically about the unique guidance needs for those populations.
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From page 32... ...
We need to have these community conversations at the right level to think about how to provide the most equitable care at the time of a crisis, she pleaded. From the specific viewpoint of supply chain and how private companies play a role, stakeholders should be thinking about opportunities to consider workforce and community education in understanding and crafting an equitable response.
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