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Barriers to Integrating
Crisis Standards of Care Principles
into International Disaster
Response Plans
Workshop Summary
Bruce M. Altevogt, Clare Stroud, and Theresa Wizemann,
Rapporteurs
Forum on Medical and Public Health Preparedness
for Catastrophic Events
Board on Health Sciences Policy
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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board
of the National Research Council, whose members are drawn from the councils of the National
Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The members of the committee responsible for the report were chosen for their special
competences and with regard for appropriate balance.
This project was supported by contracts between the National Academy of Sciences and the
American College of Emergency Physicians; the American Hospital Association; the Ameri-
can Medical Association; the American Nurses Association; the Association of State and Ter-
ritorial Health Officials; the Centers for Disease Control and Prevention (Contract No. 200-
2005-13434 TO #6); the Department of the Army (Contract No. W81XWH-08-P-0934); the
Department of Health and Human Services’ National Institutes of Health (Contract No. N01-
OD-4-2139 TO #198 and TO #244); the Department of Health and Human Services’ Office of
the Assistant Secretary for Preparedness and Response (Contract Nos. HHSP233200900680P,
HHS P23320042509X1); the Department of Homeland Security’s Office of Health Affairs
(Contract No. HSHQDC-07-C-00097); the Department of Homeland Security’s Federal Emer-
gency Management Agency (Contract No. HSFEHQ-08-P-1800); the Department of Transpor-
tation’s National Highway Traffic Safety Administration (Contract No. DTNH22-10-H-
00287); the Department of Veterans Affairs (Contract No. V101(93)P-2136 TO #10); the
Emergency Nurses Association; the National Association of Chain Drug Stores; the National
Association of County and City Health Officials; the National Association of Emergency Med-
ical Technicians; the Pharmaceutical Research and Manufacturers of America; the Robert
Wood Johnson Foundation; and the United Health Foundation. The views presented in this
publication are those of the editors and attributing authors and do not necessarily reflect the
views of the organizations or agencies that provided support for this project.
International Standard Book Number-13: 978-0-309-22178-8
International Standard Book Number-10: 0-309-22178-1
Additional copies of this report are available from the National Academies Press, 500 Fifth
Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313;
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For more information about the Institute of Medicine, visit the IOM home page at:
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Copyright 2012 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
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and religions since the beginning of recorded history. The serpent adopted as a logotype by the
Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche
Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2012. Barriers to integrating crisis standards
of care principles into international disaster response plans: Workshop summary. Washington,
DC: The National Academies Press.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating
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search Council.
www.national-academies.org
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Workshop Planning Committee*
FREDERICK BURKLE, Harvard School of Public Health
DAN HANFLING, Inova Health System, Falls Church, VA
IOM Staff
BRUCE ALTEVOGT, Preparedness Forum Director
CLARE STROUD, Program Officer
ANDREW M. POPE, Director, Board on Health Sciences Policy
ALEX REPACE, Senior Program Assistant
________________________
Institute of Medicine planning committees are solely responsible for organizing the
workshop, identifying topics, and choosing speakers. The responsibility for the published
workshop summary rests with the workshop rapporteurs and the institution.
v
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Forum on Medical and Public Health Preparedness
for Catastrophic Events*
ROBERT KADLEC (Cochair), PRTM Management Consultants,
Washington, DC
LYNNE KIDDER (Cochair), Center for Excellence in Disaster
Management and Humanitarian Assistance, Tripler AMC, Honolulu,
Hawaii (from September 2010)
ALEX ADAMS, National Association of Chain Drug Stores Foundation,
Alexandria, VA
DAMON ARNOLD, Association of State and Territorial Health
Officials, Arlington, VA
GEORGES BENJAMIN, American Public Health Association,
Washington, DC
D. W. CHEN, Office of Assistant Secretary of Defense for Health
Affairs, Department of Defense, Washington, DC
VICTORIA DAVEY, Department of Veterans Affairs, Washington, DC
JEFFREY DUCHIN, Seattle & King County and University of
Washington, Seattle
ALEXANDER GARZA, Department of Homeland Security,
Washington, DC
JULIE GERBERDING, Merck Vaccines, West Point, PA (since
September 2010)
LEWIS GOLDFRANK, New York University Medical Center, New
York
LYNN GOLDMAN, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD (until September 2010)
DAN HANFLING, Inova Health System, Falls Church, VA
JACK HERRMANN, National Association of County and City Health
Officials, Washington, DC
JAMES JAMES, American Medical Association, Chicago, IL
JERRY JOHNSTON, National Association of Emergency Medical
Technicians, Mt. Pleasant, IA
BRIAN KAMOIE, The White House, Washington, DC
________________________
*
Institute of Medicine forums and roundtables do not issue, review, or approve
individual documents. The responsibility for the published workshop summary rests with
the workshop rapporteurs and the institution.
vii
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LISA KAPLOWITZ, HHS Office of the Assistant Secretary for
Preparedness and Response, Washington, DC
ALI KHAN, Centers for Disease Control and Prevention, Atlanta, GA
MICHAEL KURILLA, National Institute of Allergy and Infectious
Diseases, Bethesda, MD
JAYNE LUX, National Business Group on Health, Washington, DC
ANTHONY MACINTYRE, American College of Emergency
Physicians, Washington, DC
ANGELA MCGOWAN, Robert Wood Johnson Foundation,
Princeton, NJ
MARGARET MCMAHON, Emergency Nurses Association,
Williamstown, NJ
MATTHEW MINSON, Texas A&M University, College Station, TX
ERIN MULLEN, Pharmaceutical Research and Manufacturers of
America, Washington, DC
CHERYL PETERSON, American Nurses Association, Silver
Spring, MD
STEVEN PHILLIPS, National Library of Medicine, Bethesda, MD
ROSLYNE SCHULMAN, American Hospital Association,
Washington, DC
RICHARD SERINO, Federal Emergency Management Agency,
Washington, DC
SHARON STANLEY, American Red Cross, Washington, DC
ERIC TONER, University of Pittsburgh Medical Center, Pittsburgh, PA
REED TUCKSON, UnitedHealth Group, Minneapolis, MN
MARGARET VANAMRINGE, The Joint Commission,
Washington, DC
GAMUNU WIEJETUNGE, National Highway Traffic Safety
Administration, Washington, DC
IOM Staff
BRUCE ALTEVOGT, Project Director
CLARE STROUD, Program Officer
ANDREW M. POPE, Director, Board on Health Sciences Policy
KRISTIN VISWANATHAN, Research Associate
ALEX REPACE, Senior Program Assistant
viii
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Reviewers
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with
procedures approved by the National Research Council’s Report Review
Committee. The purpose of this independent review is to provide candid
and critical comments that will assist the institution in making its pub-
lished report as sound as possible and to ensure that the report meets
institutional standards for objectivity, evidence, and responsiveness to
the study charge. The review comments and draft manuscript remain
confidential to protect the integrity of the process. We wish to thank the
following individuals for their review of this report:
Michael Allswede, Oklahoma State University
Knox Andress, Louisiana Poison Center
John Coleman, South Island Shared Service Agency Limited
Kobi Peleg, Israeli National Center for Trauma and Emergency
Medicine Research
Although the reviewers listed above have provided many construc-
tive comments and suggestions, they did not see the final draft of the re-
port before its release. The review of this report was overseen by
Georges C. Benjamin, American Public Health Association. Appointed
by the Institute of Medicine, he was responsible for making certain that
an independent examination of this report was carried out in accordance
with institutional procedures and that all review comments were careful-
ly considered. Responsibility for the final content of this report rests en-
tirely with the authoring committee and the institution.
ix
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Contents
INTRODUCTION 1
SURGE CAPACITY PLANNING AND CRISIS STANDARDS
OF CARE 2
Defining Crisis Standards of Care, 3
Developing National/Regional Crisis Standards of Care:
The Duty to Plan, 11
Operationalizing Crisis Standards of Care in Diverse
International Settings, 13
Ethical Framework, 15
Community and Stakeholder Engagement and Education, 16
THE INTERNATIONAL HEALTH REGULATIONS
TREATY 18
The IHR in Practice: The 2009 H1N1 Influenza Pandemic, 20
The IHR as a Potential Framework for International Surge
Planning and Crisis Standards of Care, 21
CLOSING COMMENTS 22
APPENDIXES
A References 23
B Agenda 27
xi
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