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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Crisis Standards of Care

A Systems Framework for Catastrophic Disaster Response

Volume 1: Introduction and CSC Framework

Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations

Board on Health Sciences Policy

Dan Hanfling, Bruce M. Altevogt, Kristin Viswanathan, and Lawrence O. Gostin, Editors

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
×

THE NATIONAL ACADEMIES PRESS

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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 study was supported by Contract No. HHSP23320042509XI between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

Crisis standards of care : a systems framework for catastrophic disaster
response / Committee on Guidance for Establishing Standards of Care for Use in
Disaster Situations, Board on Health Sciences Policy ; Dan Hanfling … [et al.], editors.

    p. ; cm.

Includes bibliographical references.

ISBN 978-0-309-25346-8 (hardcover) — ISBN 978-0-309-25347-5 (pdf) I. Hanfling, Dan.

II. Institute of Medicine (U.S.). Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations.

[DNLM: 1. Disaster Medicine—standards—United States. 2. Emergency Medical Services—standards—United States. 3. Emergency Treatment—standards—United States. WA 295]

 

363.34—dc23

2012016602

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; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2012 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures 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. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.

—Goethe

image

INSTITITE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

 

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
×

COMMITTEE ON GUIDANCE FOR ESTABLISHING STANDARDS OF CARE FOR USE IN DISASTER SITUATIONS

LAWRENCE O. GOSTIN (Chair), O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC

DAN HANFLING (Vice-Chair), Inova Health System, Falls Church, VA

DAMON T. ARNOLD, Illinois Department of Public Health, Chicago (retired)

STEPHEN V. CANTRILL, Denver Health Medical Center, CO

BROOKE COURTNEY, Food and Drug Administration, Bethesda, MD

ASHA DEVEREAUX, California Thoracic Society, San Francisco, CA

EDWARD J. GABRIEL,* The Walt Disney Company, Burbank, CA

JOHN L. HICK, Hennepin County Medical Center, Minneapolis, MN

JAMES G. HODGE, JR., Center for the Study of Law, Science, and Technology, Arizona State University, Tempe

DONNA E. LEVIN, Massachusetts Department of Public Health, Boston

MARIANNE MATZO, University of Oklahoma Health Sciences Center, Oklahoma City

CHERYL A. PETERSON, American Nurses Association, Silver Spring, MD

TIA POWELL, Montefiore-Einstein Center for Bioethics, Albert Einstein College of Medicine, New York, NY

MERRITT SCHREIBER, University of California, Irvine, School of Medicine

UMAIR A. SHAH, Harris County Public Health and Environmental Services, Houston, TX

JOLENE R. WHITNEY, Bureau of Emergency Medical Services (EMS) and Preparedness, Utah Department of Health, Salt Lake City

Study Staff

BRUCE M. ALTEVOGT, Study Director

ANDREW M. POPE, Director, Board on Health Sciences Policy

CLARE STROUD, Program Officer

LORA TAYLOR, Senior Project Assistant (until January 2012)

ELIZABETH THOMAS, Senior Project Assistant (since February 2012)

KRISTIN VISWANATHAN, Research Associate

RONA BRIER, Editor

BARBARA FAIN, Consultant for Public Engagement

_________________

* Resigned from the committee October 2011.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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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 published 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 deliberative process. We wish to thank the following individuals for their review of this report:

Richard Alcorta, Maryland Institute for Emergency Medical Services Systems

Knox Andress, Louisiana Poison Center

Connie Boatright-Royster, MESH Coalition

Susan Cooper, Tennessee Department of Health

Lance Gable, Wayne State University Center for Law and the Public’s Health

Carol Jacobson, Ohio Hospital Association

Amy Kaji, Harbor-UCLA Medical Center

Jon Krohmer, Department of Homeland Security

Onora Lien, King County Healthcare Coalition

Suzet McKinney, The Tauri Group

Peter Pons, Denver Health Medical Center

Clifford Rees, University of New Mexico School of Law

Linda Scott, Michigan Department of Community Health

Robert Ursano, Uniformed Services University School of Medicine

Lann Wilder, San Francisco General Hospital and Trauma Center

Matthew Wynia, American Medical Association

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
×

its release. The review of this report was overseen by Dr. Georges 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 carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
×

Acronyms

AHRQ Agency for Healthcare Research and Quality
AMA American Medical Association
APHA American Public Health Association
ASPR Assistant Secretary for Preparedness and Response
ASTHO Association of State and Territorial Health Officials
   
CDC Centers for Disease Control and Prevention
CONOPS concept of operations
CSC crisis standards of care
   
DHS Department of Homeland Security
DOD Department of Defense
   
EMAC Emergency Management Assistance Compact
EMS emergency medical services
EMTALA Emergency Medical Treatment and Active Labor Act
EOC emergency operations center
EUA emergency use authorization
   
FDA Food and Drug Administration
   
HCC health care coalition
HCF health care facility
HCPHES Harris County Public Health and Environmental Services
HHS Department of Health and Human Services
HICS hospital incident command system
HIPAA Health Insurance Portability and Accountability Act
HPP Hospital Preparedness Program
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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ICU intensive care unit
IOM Institute of Medicine
   
MAC medical advisory committee
MCE mass casualty event
MEMS Modular Emergency Medical System
MIMAL Model Intrastate Mutual Aid Legislation
MOU memorandum of understanding
MRC Medical Reserve Corps
MSCC Medical Surge Capacity and Capability
MSEHPA Model State Emergency Health Powers Act
   
NACCHO National Association of County and City Health Officials
NCCUSL National Conference of Commissioners on Uniform State Laws
NDMS National Disaster Medical System
NIMS National Incident Management System
NLE National Level Exercise
NRF National Response Framework
NSAID nonsteroidal anti-inflammatory drug
   
OSHA Occupational Safety and Health Administration
   
PACU postanesthesia care unit
PC palliative care
PHEP Public Health Emergency Preparedness
PPE personal protective equipment
PREP Public Readiness and Emergency Preparedness
PTSD posttraumatic stress disorder
   
RDMAC regional disaster medical advisory committee
RMCC regional medical coordination center
   
SARS severe acute respiratory syndrome
SDMAC state disaster medical advisory committee
SNS Strategic National Stockpile
SOFA Sequential Organ Failure Assessment
   
UEVHPA Uniform Emergency Volunteer Health Practitioners Act
   
VA Department of Veterans Affairs
VHP volunteer health practitioner
VPA Volunteer Protection Act
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. doi: 10.17226/13351.
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Catastrophic disasters occurring in 2011 in the United States and worldwide--from the tornado in Joplin, Missouri, to the earthquake and tsunami in Japan, to the earthquake in New Zealand--have demonstrated that even prepared communities can be overwhelmed. In 2009, at the height of the influenza A (H1N1) pandemic, the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, along with the Department of Veterans Affairs and the National Highway Traffic Safety Administration, asked the Institute of Medicine (IOM) to convene a committee of experts to develop national guidance for use by state and local public health officials and health-sector agencies and institutions in establishing and implementing standards of care that should apply in disaster situations-both naturally occurring and man-made-under conditions of scarce resources.

Building on the work of phase one (which is described in IOM's 2009 letter report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations), the committee developed detailed templates enumerating the functions and tasks of the key stakeholder groups involved in crisis standards of care (CSC) planning, implementation, and public engagement-state and local governments, emergency medical services (EMS), hospitals and acute care facilities, and out-of-hospital and alternate care systems. Crisis Standards of Care provides a framework for a systems approach to the development and implementation of CSC plans, and addresses the legal issues and the ethical, palliative care, and mental health issues that agencies and organizations at each level of a disaster response should address. Please note: this report is not intended to be a detailed guide to emergency preparedness or disaster response. What is described in this report is an extrapolation of existing incident management practices and principles.

Crisis Standards of Care is a seven-volume set: Volume 1 provides an overview; Volume 2 pertains to state and local governments; Volume 3 pertains to emergency medical services; Volume 4 pertains to hospitals and acute care facilities; Volume 5 pertains to out-of-hospital care and alternate care systems; Volume 6 contains a public engagement toolkit; and Volume 7 contains appendixes with additional resources.

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