stewardship, equity, and trust; (3) modify regulatory requirements to provide liability protection for health care providers making resource allocation decisions; and/or (4) designate a crisis triage officer and include provisions for palliative care in triage models for scarce resource allocation (e.g., ventilators). Crisis standards of care will usually follow a formal declaration or recognition by state government during a pervasive (pandemic influenza) or catastrophic (earthquake, hurricane) disaster which recognizes that contingency surge response strategies (resource-sparing strategies) have been exhausted, and crisis medical care must be pro–vided for a sustained period of time. Formal recognition of these austere operating conditions enables specific legal/regulatory powers and protections for health care provider allocation of scarce medical resources and for alternate care facility operations. Under these conditions, the goal is still to supply the best care possible to each patient.

Crisis surge Adaptive spaces, staff, and supplies are not consistent with usual standards of care, but provide sufficiency of care in the setting of a catastrophic disaster (i.e., provide the best possible care to patients given the circumstances and resources available). Crisis capacity activation constitutes a significant adjustment to standards of care.

Disaster medical advisory committee At the state or regional level, evaluates evidence-based, peer-reviewed critical care and other decision tools and recommends decision-making algorithms to be used when life-sustaining resources become scarce. May also be involved in providing broader recommendations regarding disaster planning and response efforts. When formed at the regional level, this group may take on the same functions as that of the clinical care committee. Those functions are focused in two distinct areas—medical advisory input and resource allocation decision approval.

Emergency Management Assistance Compact (EMAC) The first national disaster-relief compact, the EMAC has been adopted by all 50 states and the District of Columbia. It uses a responsive system that connects states with each other and federal government agencies during governor-declared emergencies, allowing them to request and send personnel, equipment, and other resources to the site of disasters.

Emergency medical services (EMS) The full spectrum of emergency care, from recognition of the emergency, telephone access of the system, and provision of prehospital care, through definitive care in the hospital. It often also includes medical response to disasters, planning for and provision of medical coverage at mass gatherings, and interfacility transfers of patients. However, for the purposes of this document, the definition of EMS is limited to the more traditional, colloquial meaning: prehospital health care for patients with real or perceived emergencies from the time point of emergency telephone access until arrival and transfer of care to the hospital.

Emergency response system A formal or informal organization covering a specified geographic area minimally composed of health care institutions, public health agencies, emergency management agencies, and emergency medical services providers to facilitate regional preparedness planning and response.

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