Rapid Expert Consultations on the COVID-19 Pandemic March 14, 2020-April 8, 2020 (2020) / Chapter Skim
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Rapid Expert Consultation on Crisis Standards of Care for the COVID-19 Pandemic (March 28, 2020)
Rapid Expert Consultation on Crisis Standards of Care for the COVID-19 Pandemic (March 28, 2020)
Pages 25-34
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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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• Senior leadership must prepare health care workers for the possible need for CSC and support them as they face the decisions that violate usual care standards. continued
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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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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. Reports on extreme conditions elsewhere may not prepare the public for the shift to CSC in their own hometowns.
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Hence, at their current state of development, these scores are not suitable for excluding patients with respiratory failure from SARS-CoV-2 from receiving critical care. Similar reservations apply to other currently available decision support tools, although their value may improve as experience accumulates with patients having SARS-CoV-2 infection.
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KEY MESSAGES AND PRINCIPLES The following key messages and principles drawn from the three seminal Insti tute of Medicine (IOM) reports, described in Appendix A, can serve as a starting point for introducing the commitments of those responsible for the shift to CSC in response to COVID-19: • We, the health care community, are doing everything possible to prevent and avoid crisis conditions and maintain conventional standards of care.
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Member Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats Dan Hanfling, M.D. Co-Chair 2009, 2012, and 2013 Institute of Medicine Crisis Standards of Care committees
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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 report3 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. The third report, published in 2013,4 focused on the development of a toolkit identifying the indicators, triggers, and tactics needed to transition from conventional care to CSC.
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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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