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D Workshop Agenda Guidance for Establishing Standards of Care for Use in Disaster Situations Board on Health Sciences Policy Public Workshop September 2, 2009 Lecture Room The National Academy of Sciences Building 2100 C Street, NW Washington, DC Workshop Goals • Examine existing standards of care protocols and identify priority elements • Examine existing guidance for triggers • Discuss the appropriate balance for guidance versus guidelines. Broad versus granular. 133

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134 CRISIS STANDARDS OF CARE GUIDANCE 8:00 a.m. Welcome and Introductions LAWRENCE GOSTIN, Committee Chair Associate Dean Research and Academic Programs Director, O'Neill Institute on National and Global Health Law Georgetown University Law Center DAN HANFLING, Committee Vice-Chair Special Advisor Emergency Preparedness and Response Inova Health System 8:15 Background and Charge to the Committee RADM ANN KNEBEL Deputy Director for Preparedness and Planning Office of the Assistant Secretary for Preparedness and Response Department of Health and Human Services 8:30 Previous National Accomplishments and Future Needs SALLY PHILLIPS Director Public Health Emergency Preparedness Agency for Healthcare Research and Quality 8:45 Federal Stakeholder Perspectives Panel Objective: Describe relevant federal efforts associated with establishing standards of care. Discuss what national guidance should look like. Discuss what should be included and what should not. Discuss benefits of establishing effective national guidance on standards of care. JON KROHMER Principal Deputy Assistant Secretary and Deputy Chief Medical Officer Office of Health Affairs Department of Homeland Security

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135 APPENDIX D CAPT DEBORAH LEVY Chief, Healthcare Preparedness Activity Division of Healthcare Quality Promotion Centers for Disease Control and Prevention ROGER BERNIER Associate Director for Science National Immunization Program Centers for Disease Control and Prevention GAMUNU WIJETUNGE NHTSA/Office of Emergency Medical Services U.S. Department of Transportation LTC(P) WAYNE HACHEY Director Preventive Medicine Office of the Assistant Secretary of Defense (Health Affairs) Force Health Protection and Readiness VIRGINIA ASHBY SHARPE Medical Ethicist National Center for Ethics in Health Care Veterans Health Administration 9:30 Discussion with Public Attendees and Committee 10:00 BREAK 10:15 Guidance on Standards of Care in Medical Triage Events Panel Objective: Discuss the level of guidance necessary during medical triage events. Identify remaining gaps limiting the potential effectiveness of existing protocols. DAMON ARNOLD, Panel Chair Director Illinois Department of Public Health PAUL PATRICK Director Bureau of EMS and Preparedness State of Utah Department of Health

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136 CRISIS STANDARDS OF CARE GUIDANCE KRISTIN STEVENS Department of Emergency Management New York University Langone Medical Center MEREDITH LI-VOLLMER Risk Communication Specialist Seattle and King County Department of Public Health STEVE ROTTMAN Director Center for Public Health and Disasters University of California, Los Angeles 11:15 Discussion with Public Attendees and Committee 11:45 Working Lunch: Continued Discussion with Public Attendees and Committee 12:30 Changing Roles and Responsibilities of Healthcare Workers under Contingency and Crisis Standards of Cares Panel Objective: Examine how healthcare worker responsibilities change along the standard of care continuum. Explore the necessary guidance desired by healthcare workers. CHERYL PETERSON, Panel Chair Senior Policy Fellow Department of Nursing Practice & Policy American Nurses Association KRISTINE GEBBIE (note: Via telecon) Joan Hansen Grabe Dean Hunter-Bellevue School of Nursing

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137 APPENDIX D STEVEN LAWRENCE Associate Director, Emergency Response Planning Midwest Regional Center of Excellence for Biodefense and Emerging Infectious Diseases Research Assistant Professor of Medicine Division of Infectious Diseases Washington University School of Medicine ROY ALSON Medical Director, Forsyth County EMS Medical Director, Disaster Services North Carolina Office of EMS MARK GOLDSTEIN Emergency Services Operations Manager Emergency Department Memorial Health System, CO 1:15 Discussion with Public Attendees and Committee 1:45 Guidance on Legal, Ethical, and Practical Issues in Setting Standards of Care in Declared Emergencies Panel Discussion: Discuss legal, ethical and practical issues associated with setting standards of care during disaster situations. Examine legal distinctions between standards of care and scope of practice. JAMES HODGE, Panel Chair Lincoln Professor of Health Law and Ethics Sandra Day O’Connor College of Law at Arizona State University STEPHEN TERET Professor Associate Dean; Director Center for Law and the Public's Health Johns Hopkins Bloomberg School of Public Health

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138 CRISIS STANDARDS OF CARE GUIDANCE CLIFFORD REES Research Assistant Professor Department of Emergency Medicine, Center for Disaster Medicine University of New Mexico School of Medicine MATTHEW WYNIA Director of the Institute for Ethics American Medical Association MARY ANN BUCKLEY Senior Attorney New York State Department of Public Health 2:30 Discussion with Public Attendees and Committee 3:00 Identifying Triggers: Identifying the shift from “conventional” to “contingency” and then “crisis” surge capacity situations Panel Objectives: Discuss the appropriate level of guidance and parameters required in the framework for guidance from a clinical perspective. Examine how to develop guidance so that it matches the available resources and evidence-based clinical outcomes, while ensuring the greatest number of people saved. JOHN HICK, Panel Chair Associate Medical Director for EMS and Medical Director of Emergency Preparedness Hennepin County Medical Center, MN ANTHONY MACINTYRE Associate Professor Department of Emergency Medicine The George Washington University BETSY WEINER (Note: via telecon) Associate Director Nursing Emergency Preparedness Education Coalition Senior Associate Dean, Informatics Vanderbilt University School of Nursing

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139 APPENDIX D JAMES GEILING Associate Professor of Medicine Dartmouth Medical School LESLEE STEIN-SPENCER (Note: via telecon) Manager of Quality Improvement, Chicago Fire Department Program Advisor, National Association of State EMS Officials GEORGE TURABELIDZE Deputy State Epidemiologist Missouri Department of Health and Senior Services BRIAN ERSTAD Professor and Assistant Department Head Pharmacy Practice and Science University of Arizona, College of Pharmacy 4:15 Discussion with Public Attendees and Committee 4:45 Revisiting Overarching Themes: Discussion with Public Attendees and Committee LAWRENCE GOSTIN, Committee Chair Associate Dean Research and Academic Programs Director, O'Neill Institute on National and Global Health Law Georgetown University Law Center DAN HANFLING, Committee Vice-Chair Special Advisor Emergency Preparedness and Response Inova Health System 5:30 ADJOURN

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