circumstances, it may not even be possible to provide basic life-sustaining interventions to all patients who need them.

In recent years, a number of federal, state, and local efforts have taken place to develop crisis standards of care protocols and policies for use in conditions of overwhelming resource scarcity. Those involved in these efforts have begun to carefully consider these difficult issues and to develop plans that are ethical, consistent with the community’s values, and implementable during a crisis. These planning efforts are essential because, absent careful planning, there is enormous potential for confusion, chaos, and flawed decision making in a catastrophic public health emergency or disaster.

However, although these efforts have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. Furthermore, the efforts have mainly been taking place independently, leading to a lack of consistency across neighboring jurisdictions and unnecessary duplication of effort. Lastly, many states have not yet substantially begun to develop policies and protocols for crisis standards of care during a mass casualty event.

These issues prompted the Institute of Medicine’s (IOM’s) Forum on Medical and Public Health Preparedness for Catastrophic Events (Preparedness Forum) to organize a series of regional workshops on this topic. These workshops were held in Irvine, CA; Orlando, FL; New York, NY; and Chicago, IL, between March and May of 2009.


The IOM’s Preparedness Forum was established to foster dialogue among a broad range of stakeholders—practitioners, policy makers, community members, academics, and others—and to provide ongoing opportunities to confront issues of mutual interest and concern. The Forum provides a neutral venue for broad-ranging policy discussions that can aid in coordination and cooperation between public and private stakeholders in developing and enhancing the nation’s medical and public health preparedness. Sponsoring members include federal agencies, state and local associations, health professional associations, and private-sector business associations.

The goals of the workshops on Crisis Standards of Care were to learn from the work already being done to develop state, regional, and local crisis standards of care policies and protocols; to identify areas that re-

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