2State Public Authority Process: State Disaster Medical Advisory Committee

(EMS) experts and members of the public (represented by key faith, cultural, and at-risk group representatives) to provide advice on pandemic preparedness. This group suggested enabling legislation for declaring a public health emergency, improving liability protection during disasters for volunteer and non-volunteer healthcare providers, and expanding the scope of practice for many healthcare providers. A smaller medical advisory committee2 of critical care, infectious disease, emergency, and pediatric physicians developed draft guidelines dealing with potential alterations in the healthcare system during the time of a pandemic. These guidelines dealt with alteration in standards of care to crisis standards of care, if necessary, during a pandemic, addressing issues such as intensive care unit (ICU) admission criteria using Sequential Organ Failure Assessment (SOFA) scoring and ventilator allocation based on work done in New York and Minneapolis. These guidelines were carefully reviewed by the larger advisory committee with state-wide provider and community engagement and incorporated the ethical principles3 of fairness, duty to care, duty to steward resources, transparency, consistency across institutions and accountability. This group also established indicators4 (ICU bed availability, ventilator availability, emergency department [ED] average wait times) to follow on regional and state levels to assist in the monitoring of disease progression and status, which were already tracked by a state-wide EMS and hospital monitoring system5. The Disaster Medical Advisory Committee was tasked with obtaining quarterly data from this system and determining thresholds that would prompt an alert to the regional hospital coalition that patient care demand for services was increasing. State preparation also included planning for the establishment of alternate care facilities, if necessary, for acute, palliative, and behavioral health care. Purchases of antiviral medications, N95 masks, materials to provide care at an alternate care site, and a small number of ventilators were purchased using federal grant funding as well as a state legislative appropriation.

3Ethical Elements: Core ethical components listed

4Indicators and Triggers: Event-specific resource availability

5Indicators and Triggers: Situational awareness monitoring



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