Evolving Crisis Standards of Care and Ongoing Lessons from COVID-19 Proceedings of a Workshop Series (2022) / Chapter Skim
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2 Reflections, Inflections, and the Future
2 Reflections, Inflections, and the Future
Pages 5-18
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From page 5... ...
THE FIRST 10 YEARS OF CRISIS STANDARDS OF CARE When the Forum on Medical and Public Health Preparedness for Disasters and Emergencies convened the workshop Crisis Standards of Care: Ten Years of Successes and Challenges in November 2019,1 the first cases of COVID-19 were already appearing in Wuhan, China. Dan Hanfling, vice president of Technical Staff at In-Q-Tel, noted that this unfortunate pandemic experience has provided an opportunity to reexamine the CSC 1 https://www.nap.edu/catalog/25767/crisis-standards-of-care-ten-years-of-successes-andchallenges (accessed January 5, 2022)
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. By having enhanced preparedness and availability of resources, he said, the time available before entering the area under that FIGURE 2-1 Demand for health care services and supply of resources as a function of time after disaster onset, taking into account care capacity as a function of time.
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They instead shifted to other means of managing patients such as placing them prone to provide more oxygen. FIGURE 2-2 Structural metaphor resembling the Lincoln Memorial for CSC planning.
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, and founder and general manager of East West Protection, LLC, provided three different, successful scenarios to elucidate the range of situations that could call upon CSC planning. Developing CSC Planning for Nationwide Hospitals The first scenario refers to HCA Healthcare, a nationwide health system, and how it approached CSC in early March 2020 in response to
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The issue of CSC had been lurking in the background for HCA Healthcare, but by February 2020 the leadership realized CSC challenges needed to be addressed in a systematic way. In March 2020, ASPR began working with HCA Healthcare and its lawyers, clinical staff, and chief medical officers to develop an effective CSC program that prioritized resource sparing2 and contingency standards.
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Beginning in late March 2020, hospitals in that community began to realize they needed to develop a strong contingency plan that focused on resource sparing so they could continue to manage the patient flow confronting them. They decided to set up alternate care sites to decompress their hospitals and support intensive care capability, he explained, but they wanted to do it in a way that was ethical and accountable.
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He explained that the state wanted to ensure the community understood the alternate care site was not to be a depository for COVID-19 patients, but that it would be built around principles of equity and rehabilitation services to get recovered patients back into their home environment in the best shape possible. The community did have strong political leadership and support at the local level from the mayor and the county judge executive, who supported hospitals collectively taking advantage of alternate care sites with common messaging and discharge criteria.
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Mehta noted that politicians talk about how staff can be stretched thinner, but eventually it does affect patient safety and morale in the field, with recent reports of 30 percent of health care workers considering leaving the field (Wan, 2021)
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For example, nurses and ancillary staff have moved from nursing homes and long-term care centers to acute hospitals and health care facilities to help with the increased surge of patients during the pandemic, creating a workforce shortage in nursing homes. This then makes it difficult for hospitals to offload patients who are ready to recover, so bed availability is still a challenge.
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Legal Lessons and Accountability Jennifer Piatt, deputy director for the Network for Public Health Law– Western Region Office, offered lessons related to legal issues throughout the 3 Load-balancing activities may include prehospital distribution of patients in other health care facilities in the area, patients transfers between facilities, or sharing resources between different facilities.
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Piatt added that it will be important to guarantee that adequate liability protections are in place to ensure that health care workers remain willing and able to provide services in crisis scenarios, but that it is also important not to go too far in that direction, and maintain levels of accountability by not protecting actions that are willful. Piatt concluded that one of the most important issues that emerged in this process of operationalization was equity.
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Hanfling also saw an opportunity for health care coalitions to play a role in bringing information up from the local level. He noted that the goal of CSC planning is to have situational awareness driving decision making to avoid having to ration care.
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, which emerged in 2003, and 2.5 percent as lethal as Middle East respiratory syndrome (MERS) , affecting multiple countries since 2015; the need for robust and engaged CSC planning is even more critical now than we thought it was in 2009, he stated.
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