IOM Issues New Report on Crisis Standards of Care
By Matthew Watson, March 30, 2012
On March 21, 2012, the Institute of Medicine’s (IOM) Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations released Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response,1 which is the second IOM report on crisis standards of care (CSC). The first, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations – Letter Report,2 released in 2009, defined CSC as a “substantial change in the usual health care operations and the level of care it is possible to deliver . . . justified by specific circumstances and . . . formally declared by a state government in recognition that crisis operations will be in effect for a sustained period.”1 This report is a valuable addition to the literature on CSC because it provides a comprehensive overview of the topic and much needed guidance for practitioners. It warrants review by all interested in this issue.
A comprehensive summary of the document is beyond the scope of the CBN; instead, we are highlighting 2 particularly important aspects― the disaster response framework and milestones for planning and implementation. (Of note: The report does not describe specific triggers, indicators, or operational guidelines, as they would vary according to the nature and location of a disaster.)
Practical Guidance on Implementation
The medical disaster response community has long recognized the need for well-defined CSC and practical guidance on implementation. However, planning has been slowed by the challenges of engaging and organizing the many disciplines, actors, and agencies involved in disaster response. This new guidance, organized into 7 volumes, addresses that issue by suggesting a systems-based approach that embraces the interests and needs of multiple communities of practice, including state and local government, emergency medical services (EMS), hospitals, alternate care systems, and public engagement specialists.
The IOM’s conceptual framework delineates the players and processes that comprise such a system. In this model, government efforts are supported by 5 operational pillars (e.g., public health and hospital care), which are undergirded by key organizational processes (e.g., community and provider engagement), all of which rest on a foundation of ethical and legal considerations.
Integrating CSC into Existing Plans
The IOM report also includes milestones to guide integration of CSC into existing disaster plans and suggests the appropriate agencies and entities to lead each stage of effort (below). Interagency cooperation is emphasized, particularly at the state level.
Proposed Lead Agencies
The report concludes with several additional recommendations as well:
- Each level of government should ensure coordination of and consistency in the active engagement of all partners in the emergency response system, including emergency management, public health, emergency medical services, public and private healthcare providers and entities, and public safety.
- Each level of government should integrate CSC into surge capacity and capability planning and exercises.
- The Department of Health and Human Services/Assistant Secretary for Preparedness and Response (eg, through its regional emergency coordinators) should facilitate CSC planning and response among state and tribal governments within their region.
- In CSC planning and response efforts, states should collaborate with and support local governments.
- Federal disaster preparedness and response grants, contracts, and programs—such as the Hospital Preparedness Program, Public Health Emergency Preparedness Program, Metropolitan Medical Response System, Community Environmental Monitoring Program, and Urban Areas Security Initiative—should integrate relevant CSC functions.1
- Institute of Medicine. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. 2012. Washington, DC: The National Academies Press. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Accessed March 29, 2012.
- Institute of Medicine. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. 2009. Washington, DC: The National Academies Press. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations – Letter Report. Accessed March 29, 2012.