Crisis Standards of Care Ten Years of Successes and Challenges: Proceedings of a Workshop (2021) / Chapter Skim
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5 Implementing Crisis Standards of Care Across Sectors
5 Implementing Crisis Standards of Care Across Sectors
Pages 33-46
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From page 33... ...
This chapter summarizes the highlights across the six sectors, as well as some common areas that emerged across the system that can guide the forum and relevant stakeholders in future planning. EMERGENCY MEDICAL SERVICES Challenges and Opportunities Ira Nemeth, associate medical director for EMS and LifeFlight at UMass Memorial Hospital, reported out from the EMS group on challenges and opportunities for CSC.
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From page 34... ...
Other areas for improvement described by several participants include working within a region to ensure that the EMS office, which is usually housed within the public health department at the state level, is connected to those in public health working on CSC, as well as the other critical first responders such as police, firefighters, emergency managers, and those who run the dispatch center. These are all important players, he said, but they often are not engaged on this topic and do not participate.
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From page 35... ...
According to Huleatt, most of the process has been much more dynamic. Huleatt suggested possibly shifting the terminology to "creating a framework" instead of "developing a CSC plan" and that finding terms that work for the majority can help get more people to the table, such as through hospital partnerships.
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He added a last opportunity of leveraging the breadth of public health as a strength. "We can be a liaison role to the emergency operations center," he said, "a conduit to local emergency management, the acute hospital setting; it's important for local health to be the connector." Exploring the Way Forward "The first observation I have," Huleatt posited, "is a theme to generate awareness of the CSC planning process, including what it is, how it is socialized, and other related campaigns." That kept emerging during discussions, he said.
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and engagement to add value to CSC planning efforts, as demonstrated through the numerous infrastructure issues that were presented at the workshop, creating complex challenges outside of hospital walls. HEALTH CARE SETTINGS Challenges and Opportunities Eric Toner, senior scholar at the Johns Hopkins Center for Health Security, presented the salient points from the discussion of challenges and opportunities among participants in the health care setting related to CSC.
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Exploring the Way Forward For concrete suggestions on immediate future actions for the health care setting, John Hick, professor of emergency medicine and medical director of emergency preparedness, Hennepin Healthcare, University of Minnesota, shared a series of ideas from their wide-ranging discussion: • Enhance the CSC conversation -- share more of the conceptual ele ments at national conferences to advance the framework. • Partner with large employers -- their crisis communications and ability to leverage occupational health offices, closed points of dispensing, and other resources can provide an extension of the health care system.
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• Test CSC operational frameworks -- offering functional exercises and scenarios based on real-world examples. Drawing on lessons learned from events like the Las Vegas shooting can inform exer cise toolkits that health care facilities can use to advance their process.
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Understand what role predictive modeling tools play in driving decision making, who owns those decisions, and who is looking at trigger points across the supply chain and making those decisions. • Ensuring consistency across sectors with regard to planning assumptions, so that all supply-chain stakeholders can operate under the same scenarios.
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From page 41... ...
She also called for more research specifically on combined burn and radiation, and highlighted the importance of a trained workforce in this area and the current lack of capacity for subspecialties. Articulating the Way Forward Providing thoughts on future actions for subspecialties in the CSC planning context, Lyon explained that there is a need to identify levers of implementation and spread of CSC, including champions for each lever.
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Include CSC in standards of emergency preparedness for regulatory bodies. • Data: Establish a data registry for drills and actual events.
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This could provide rapid access, just-in-time legal advice with subject-matter experts. She also suggested having advanced standing orders that can be applied in various scenarios ahead of a declared emergency.
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Potential solutions ranged from presenting the topic at more national-level conferences across various sectors -- whether health care or EMS or subspecialties -- to broaden mindsets when thinking of what "CSC" looks like, or what type of event warrants a CSC discussion. A few participants had also suggested leaning away from the catastrophic examples of events that would result in CSC, because they are much lower in likelihood, and instead trying to engage more people by focusing on the more routine daily emergencies that might dictate contingency standards.
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From page 45... ...
In Illinois, we used the term "catastrophic emergency annex" because the emergency managers in the state said they did not understand "CSC," but how an "annex" fits within their overall emergency operating plan makes sense to them. While multiple participants suggested the creation of a toolkit or implementation guides, and moving between phases in the continuum, Hanfling pointed out that the 2013 report released by the Institute of Medicine identified specific actions for each sector that could be used as a starter kit (IOM, 2013a)
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46 CSC: TEN YEARS OF SUCCESSES AND CHALLENGES where proactive triage guidelines were well intentioned but having a fraught declaration with sweeping powers may not always be helpful for the problem at hand -- so rushing to use legal powers just because they exist does not mean they are indicated to solve that problem in that setting. We need to help providers understand that they should be doing everything they can to stay as close to conventional care as possible, he said.
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