Critical Findings on COVID-19 Select Publications from the National Academies of Sciences, Engineering, and Medicine (2021) / 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 22-30
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From page 22... ...
Assistant Secretary for Preparedness and Response 200 Independence Avenue, SW Washington, DC 20201 Dear ADM Giroir and Dr. 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.
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From page 23... ...
This is the current and likely future reality for many institutions caring for the growing numbers of patients with SARS CoV-2 infection. Crisis Standards of Care Definition, Guiding Principles, and Key Elements of Planning Crisis standards of care are applied when a pervasive or catastrophic disaster make it impossible to meet usual health care standards.
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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. Legal Considerations • Health care workers who must make difficult decisions implementing CSC must have adequate guidance and legal protections.
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Ultimately, this shift represents not a rejection of ethical principles but their embodiment. 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.
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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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From page 27... ...
These measures must be taken at all levels of government, the health care system, and society. There is also an imminent need to prepare for difficult decisions about allocating limited resources, triaging patients to receive life-saving care, and minimizing the negative impacts of delivering care under crisis conditions.
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• We recognize that the principal goal of implementing CSC is to maximize benefits to society, which includes saving as many lives -- patients, health care workers, and front-line first responders -- as possible. CSC decisions allocate scarce treatment resources to those patients who are most likely to benefit, consistent with community values as articulated by bodies convened for this purpose (see Appendix A)
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From page 29... ...
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. 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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APPENDIX B Authors and Reviewers of This Rapid Expert Consultation This rapid expert consultation was prepared by Dan Hanfling, In-Q-Tel, and John Hick, Hennepin County Medical Center, as the co-conveners of the CSC working group under the auspices of the National Academies' Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats. 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.
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