CRISIS STANDARDS OF CARE
Ten Years of Successes and Challenges
PROCEEDINGS OF A WORKSHOP
Megan Snair, Aurelia Attal-Juncqua, and Scott Wollek, Rapporteurs
Forum on Medical and Public Health Preparedness for Disasters and
Emergencies
Board on Health Sciences Policy
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported jointly by contracts between the National Academy of Sciences and the Administration for Children and Families (HHSP233201400020B/HHSP23337065), the Assistant Secretary for Preparedness and Response (HHSO100201850012A), the Centers for Disease Control and Prevention (200-2011-38807/75D30119F00077), the Food and Drug Administration (75F40120P00067), and the National Institutes of Health (HHSN263201800029I/HHSN26300026). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-67625-0
International Standard Book Number-10: 0-309-67625-8
Digital Object Identifier: https://doi.org/10.17226/25767
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Crisis standards of care: Ten years of successes and challenges: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25767.
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PLANNING COMMITTEE ON CRISIS STANDARDS OF CARE: TEN YEARS OF SUCCESSES AND CHALLENGES1
JOHN L. HICK (Co-Chair), Professor of Emergency Medicine and Medical Director of Emergency Preparedness, Hennepin Healthcare, University of Minnesota
SUZET M. McKINNEY (Co-Chair), Executive Director and Chief Executive Officer, Illinois Medical District
BROOKE COURTNEY, Senior Regulatory Counsel, Office of Counterterrorism and Emerging Threats, Food and Drug Administration
JAMES HODGE, JR., Professor of Law, Sandra Day O’Connor College of Law, Arizona State University
NIRANJAN (TEX) KISSOON, Executive Medical Director, Children’s and Women’s Global Health; UBC and BCCH Professor in Acute and Critical Care–Global Child Health, British Columbia Children’s Hospital Research Institute
NICOLETTE LOUISSAINT, Executive Director, Healthcare Ready
ANITA PATEL, Senior Special Advisor, Pandemic Medical Care and Countermeasures Lead, Centers for Disease Control and Prevention
PETER PONS, Associate Director of Emergency Medicine, Denver Health Medical Center
COLLEEN M. RYAN, Staff Surgeon, Sumner M. Redstone Burn Center and Shriners Burn Hospital, Massachusetts General Hospital; Professor of Surgery, Harvard Medical School
UMAIR SHAH, Executive Director, Harris County Public Health
STEVEN WARD, Director, Operational Medicine Readiness, Policy and Oversight, U.S. Air Force
MATTHEW K. WYNIA, Director, Center for Bioethics and Humanities, University of Colorado Denver
Health and Medicine Division Staff
SCOTT WOLLEK, Senior Program Officer
CAROLINE CILIO, Associate Program Officer (until October 2019)
KIMBERLY SUTTON, Senior Program Assistant
ANDREW M. POPE, Senior Director, Board on Health Sciences Policy
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
Consultants
LAURA RUNNELS, LAR Consulting
MEGAN SNAIR, Science Writer
FORUM ON MEDICAL AND PUBLIC HEALTH PREPAREDNESS FOR DISASTERS AND EMERGENCIES1
DAN HANFLING (Co-Chair), Vice-President, Technical Staff, In-Q-Tel
SUZET M. McKINNEY (Co-Chair), Chief Executive Officer, Illinois Medical District
STACEY J. ARNESEN, Branch Chief, Disaster Information Management Research Center, National Library of Medicine, National Institutes of Health
JOHN BENITEZ, Medical Director, Emergency Preparedness, Tennessee Department of Health
ERIC BLANK, Senior Director, Public Health Programs and Systems, Association of Public Health Laboratories
DUANCE C. CANEVA, Chief Medical Officer, Department of Homeland Security
MARY CASEY-LOCKYER, Senior Associate, Disaster Health Program Development, American Red Cross
BROOKE COURTNEY, Senior Regulatory Counsel, Office of Counterterrorism and Emerging Threats, Food and Drug Administration
JOHN J. DREYZEHNER, Director, Center for Preparedness and Response, Centers for Disease Control and Prevention
DAVID EISENMAN, Associate Professor, David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles
BRUCE EVANS, Fire Chief, Upper Pine River Fire Protection District
JAMES R. FICKE, Robert A. Robinson Professor and Director, Department of Orthopaedic Surgery, Johns Hopkins Medicine
NATALIE GRANT, Director, Office of Human Services Emergency Preparedness and Response, Administration for Children and Families, Department of Health and Human Services
LORI GRUBSTEIN, Program Officer, Health Care Group, Robert Wood Johnson Foundation
JOHN L. HICK, Professor of Emergency Medicine and Medical Director of Emergency Preparedness, Hennepin Healthcare, University of Minnesota
ROBERT KADLEC, Assistant Secretary for Preparedness and Response, Department of Health and Human Services
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
THOMAS KIRSCH, Professor of Military and Emergency Medicine, Director, National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences
NICOLETTE A. LOUISSAINT, Executive Director, Healthcare Ready
FREDA GAIL LYON, Vice President, Emergency Services, WellStar Health System
PHILLIP MAYTUBBY, Director, Public Health Protection, Oklahoma City-County Health Department
BIRGITTE MESSERSCHMIDT, Director of Applied Research, National Fire Protection Association
AUBREY K. MILLER, Senior Medical Advisor, Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health
BARBARA MULACH, Director, Office of Science Coordination and Program Operations, National Institute of Allergy and Infectious Diseases, National Institutes of Health
IRA NEMETH, Chair, Disaster Medicine Section, American College of Emergency Physicians, Associate Medical Director for EMS and LifeFlight at UMass Memorial Hospital
JOHN OSBORN, Operations Manager and Assistant Professor of Health Care Systems Engineering, Department of Surgery, Mayo Clinic College of Medicine and Science
TARA O’TOOLE, Senior Fellow and Executive Vice President, In-Q-Tel
ANDREW T. PAVIA, George and Esther Gross Presidential Professor, Division of Pediatric Infectious Diseases, University of Utah School of Medicine
LEWIS RADONOVICH, Chief of Research, National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health
TERRY RAUCH, Deputy Assistant Secretary of Defense for Health Readiness Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense
SARA ROSZAK, Vice President, Pharmacy Care and Health Strategy, National Association of Chain Drug Stores
COLLEEN M. RYAN, Staff Surgeon, Sumner M. Redstone Burn Center, Massachusetts General Hospital; Professor of Surgery, Harvard Medical School
ROSLYNE SCHULMAN, Director, Policy Development, American Hospital Association
RICHARD SERINO, Distinguished Visiting Fellow, National Preparedness Leadership Initiative, Harvard T.H. Chan School of Public Health
ALAN SINISCALCHI, Surveillance Coordinator for Influenza, Bioterrorism, and Public Health Preparedness, Connecticut Department of Public Health
W. CRAIG VANDERWAGEN, Cofounder and Director, East West Protection, LLC
TENER VEENEMA, Professor of Nursing, Johns Hopkins University
JENNIFER WARD, President, Trauma Center Association of America
GAMUNU WIJETUNGE, EMS Specialist, Office of Emergency Medical Services, National Highway Traffic Safety Administration, Department of Transportation
MATTHEW K. WYNIA, Director, Center for Bioethics and Humanities, University of Colorado Denver
Forum Staff
SCOTT WOLLEK, Forum Director
AURELIA ATTAL-JUNCQUA, Associate Program Officer
MICHAEL BERRIOS, Research Associate
KIMBERLY SUTTON, Senior Program Assistant
ANDREW M. POPE, Senior Director, Board on Health Sciences Policy
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Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BOBBIE BERKOWITZ, Columbia University School of Nursing and University of Washington. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Contents
Organization of the Proceedings
2 INFORMING THE NEXT STAGE OF CRISIS STANDARDS OF CARE
Crisis Standards of Care Terminology and Implications
Importance of Legal Frameworks
Opportunities for the Future of Crisis Standards of Care
3 ETHICAL AND LEGAL CONSIDERATIONS
Ethics in Real Life: Personal Experiences with Crisis Standards of Care
Questions and Challenges of Research to Inform Crisis Standards of Care Decisions
Individual Ethics Versus Population Ethics