Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response has
been released by the Institute of Medicine and should be required
reading for anyone who participates in emergency preparedness.
When
disaster strikes changes have to be made. Planning has to turn into
action. Public health, emergency medical service, and hospitals will be
faced with tremendous pressure to do the best for the most with what
they've got. I call this situation switching from a Standard of Care to a
Sufficiency of Care - the latest publication from the Institute of
Medicine (IOM) calls it Crisis Standard of Care. The Tenent Health/Katrina decision reinforced the health care planing message...IOM tells us how to do it -
IOM defines three levels of care:
- Conventional Care
- Contingency Care
- Crisis Care
Overview
Crisis
Standards of Care document totals over 500 pages divided into easy to
digest volumes that target key pillars of Hospital Care, Public Health,
Out of Hospital Care, EMS, and Emergency Management/Public Safety. The
standards are built on a platform of ethical considerations and legal
authority that segue into other critical, but often ignored, components
such as community engagement and creation of incidents and triggers for
action.
A
key to this document being noteworthy is the detailed incorporation of
emergency medical service, out of hospital care and public health.While
most preparedness documents clump these disciplines under the health
care umbrella, IOM takes a refreshing stance by giving each of these
disciplines receives appropriate attention and legitimate planning
guidance. The quality doesn't stop there; IOM goes even further,
including at-risk populations, palliative care, home care, and walk
in/urgent care centers as contingencies for planning.
Planning
Hospitals have a "duty to plan" and the
framework for planning and plan development is exceptionally easy to
follow. Step-by-step guidance is given in terms that are easy to
understand with a process that has a natural flow and will be a nice
addition to your 96-hour planning.
Based on my experience, this process with integrate well into existing
planning workflow. Following the IOM planning template may also help you
avoid my 7 Surefire Tips for Emergency Plan Failure. I also recommend a review of the 6 items that good plans have that bad ones don't.
Planning
 |
| Template from IOM document |
Training
Recommendations
are made for the inclusion of tabletop exercises (TTX) as a means to
testing plans created under this framework. TTXs
are my favorite training exercise; they are fantastic activities that
can be accomplished with a reasonable amount of preparation and very
little funding. Follow these links for more on tabletop exercises and exercise design. See also my five tips that will enhance your exercise design program.
Review
The IOM Crisis Standards of Care -
Review
The IOM Crisis Standards of Care -
- includes template guides for palnning
- includes EMS, public health as major players
- accounts for mental health, palliative care and at-risk populations
- call for tabletop exercises
- establishing trigger points for switching between conventional, contingency, and crisis care
- modifications for protocols/authorized use of CSC in planning
- guidance for liability protection and reimbursement
- Volume 3: EMS
- Volume 4: Hosptial
- Volume 5: Alternate Care
