BOX 3-1
Key Terms and Concepts

Crisis standards of care: “Guidelines developed before disaster strikes to help health care providers decide how to provide the best possible medical care when there are not enough resources to give all patients the level of care they would receive under normal circumstances” (IOM, 2012, p. 6-14).

Continuum of Care: Conventional, Contingency, and Crisis

Conventional capacity: The spaces, staff, and supplies used are consistent with daily practices within the institution. These spaces and practices are used during a major mass casualty incident that triggers activation of the facility emergency operations plan (Hick et al., 2009).

Contingency capacity: The spaces, staff, and supplies used are not consistent with daily practices, but provide care that is functionally equivalent to usual patient care. These spaces or practices may be used temporarily during a major mass casualty incident or on a more sustained basis during a disaster (when the demands of the incident exceed community resources) (Hick et al., 2009).

Crisis capacity: Adaptive spaces, staff, and supplies are not consistent with usual standards of care, but provide sufficiency of care in the context 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 (Hick et al., 2009).

Indicators and Triggers

Indicator: A measurement, event, or other data that is a predictor of change in demand for health care service delivery or availability of resources. This may warrant further monitoring, analysis, information sharing, and/or select implementation of emergency response system actions.

conversations on CSC is available in the Institute of Medicine’s report Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response (IOM, 2012).


Toolkit Design

The discussion toolkit is structured around two scenarios (one slow-onset and one no-notice), a series of key questions for discussion, and a set of example tables. The example indicators and triggers encompass both clinical and administrative indicators and triggers. The toolkit is designed to facilitate discussion to drive the planning process.

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