tributing to a uniform national framework for responding to crisis in a fair, equitable, and transparent manner.

TABLE 8 Impediments to Crisis Standards of Care Implementation

Key Elements

Gaps to Crisis Standards Implementation

Ethical elements

  • Articulation of community values and preferences regarding allocation of scarce resources

  • Consultation and education for practitioners and community about which actions are ethically justifiable during crisis standards, and which are not

Community and provider engagement

  • Absence of public and stakeholder discussion framework

  • Absence of “clearinghouse” repository for collected works

  • Financial impact of resource-sparing strategies

  • Financial commitments for community engagement/education processes

  • Incomplete, inconsistent regional partnership development

Legal authority and environment

  • Inconsistent liability protections

  • Inconsistent application of scope of practice

  • Uncertainty about existing liability protections

  • Uncertain role of community “informed consent”

Indicators and triggers

  • Limited situational awareness and real-time information exchange

Clinical process and operations

  • Limited evidence base for select population groups (pediatrics, geriatrics)

  • Uncertain expectations for completion of diminished documentation

  • Uncertain process for deescalation from crisis care to conventional care (return to “normalcy”)

  • Uncertain processes for developing constructive after-action reports documenting crisis care responses

  • Uncertain strategy for using community-based assets of the health system (i.e., private practices, ambulatory care clinics) in managing a crisis surge response

  • Lack of meaningful/realistic exercise opportunity to evaluate scarce resource planning

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