Evolving Crisis Standards of Care and Ongoing Lessons from COVID-19 Proceedings of a Workshop Series (2022) / Chapter Skim
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4 Crisis Standards of Care: From Plans to Reality
4 Crisis Standards of Care: From Plans to Reality
Pages 33-46
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From page 33... ...
SETTING THE STAGE Anuj Mehta, assistant professor of medicine, Denver Health and Hospital Authority, walked through the spectrum of changing needs from the conventional phase to the contingency phase to the crisis phrase and explained the different facets of CSC planning that need to occur in each phase. He explained that the conventional care phase, when there is no emergency, is when authorities and decision makers could identify the core principles on which they will be basing their decisions, as well as the key stakeholders to involve.
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From page 34... ...
IMPLEMENTATION CASE STORIES To provide varied perspectives on how CSC is implemented in different scenarios, this section provides experiences from three states across a range of planning needs, including community engagement, communication and coordination, and managing triage guidelines and workflows. Incorporating Community Input in Colorado Gina Febbraro, planning and improvement consultant, Colorado Department of Public Health and Environment (CDPHE)
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From page 35... ...
Finally, Febbraro said that because of the rapid pace of the pandemic, the team had to move very quickly and were not able to use all the best practices of community engagement that would have been ideal during conventional planning phases. Communication and Coordination in New Mexico Chris Emory, chief of the Bureau of Health Emergency Management, New Mexico Department of Health, introduced New Mexico as a very large, primarily rural frontier state with very limited resources.
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From page 36... ...
New Mexico also achieved statewide load balancing across facilities, had one central call center for the entire state, and maintained a constant continuum of care assessment, using space, staff, and supplies as core components to address the needs of various facilities. Learning from COVID-19 in New York City Elizabeth Chuang, Albert Einstein College of Medicine Montefiore Medical Center, focused her comments on the scarce resource triage component of CSC.
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From page 37... ...
It left hospitals uncertain whether triage protocols and workflows would be legitimized, and this disincentivized investment in these critical planning activities. She shared that through interviews with triage planners across the country, her team learned that states with supportive state governments had hospital leadership that was more willing to engage with triage planning and were able to conduct tabletop exercises to make the logistical steps of triage concrete and identify and correct workflow issues.
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From page 38... ...
In an effort to address standardization across the state, they trained triage officers and those working in the call center to recognize and counter implicit biases. Most stakeholders do not know what CSC plans are, added Febbraro, so there is a job to do at the state level and in partnership with hospitals to continue the education of, and communication with, stakeholders and communities.
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From page 39... ...
Some states have an EMS medical director, but some -- like Texas -- do not, so EMS medical directors have to make decisions for their local agency without state oversight. Kidd shared examples of medical director involvement in implementing CSC, such as outlining altered standards of care, and noted these are diffi
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From page 40... ...
Many EMS medical directors altered criteria for terminating resuscitation in the field, or not transporting patients to the hospital and just treating them in the field. Additionally, she explained, there were changes such as varying destinations for transport, altered dispatch protocols, and using EMS personnel in nontraditional roles (e.g., giving vaccines, working in monoclonal antibody centers)
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From page 41... ...
Many pediatric providers were used to help with messaging and public health measure compliance, helping to create honest messaging about transmission and risk to children and vaccine hesitancy. Paquette emphasized the need for coordination beyond one's own hospital system.
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From page 42... ...
During the first surge, ICU beds filled quickly, he explained, so his ICU had to develop novel spaces or double up on patients in ICU rooms. He noted that while his team did not have to allocate ventilators, other elements of critical care medicine were often in short supply, so the resource mismatch was present across all domains.
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From page 43... ...
The historical experiences the people in the coalition have endured has created a perception, she explained, but when there is a significant event that engages community leaders, new perceptions can be formed. Reiskin noted that these changes happened when people at the health department invited leaders from the disability community to come to the meetings to be part of the discussions.
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From page 44... ...
Will Stone, science reporter at National Public Radio, noted that most people had never heard of CSC before the pandemic emerged in early 2020. Once they did, early discussions focused on such extreme scenarios as having enough ventilators or beds for patients.
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From page 45... ...
He also shared that he had not heard much of CSC until the pandemic emerged, but he realized as an intensivist there were many important allocation questions that would quickly emerge in his department if there were too many patients. Erin Serino, deputy chief of staff, Boston Emergency Medical Services, commented that she saw the trends in discussions as coordination and communication across systems and at state and regional levels.
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