Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2.
Discussion Paper (National Academy of Medicine (U.S.))
Hick, John L. Hanfling, Dan. Wynia, Matthew K. Pavia, Andrew T.
Published: March 5, 2020
National Academy of Medicine
The Keck Center 500 Fifth Street, NW
Washington, DC 20001
Intended for health care planners and clinicians, this discussion paper summarizes some key areas in which principles of crisis standards of care (CSC) initially framed by the Institute of Medicine in 2009 should be applied to COVID-19 pandemic planning, with an emphasis on providing health care for a large number of patients. It explains use of the CSC ensures fair processes are in place to make clinically informed decisions about scarce resource allocation during an epidemic. This may include strategies such as preparing, conserving, substituting, adapting, re-using, and re-allocating resources. Following an introduction, the paper discusses the application of CSC principles to clinical care, personal protective equipment, staffing, and emergency medical services, and explores the outpatient and emergency department capacity challenges posed by a coronavirus or other major epidemic or pandemic event. It is explained health care facilities should be developing tiered, proactive strategies using the best available clinical information and building on their existing surge capacity plans to optimize resource use in the event the current COVID-19 outbreak spreads and creates severe resource demands, and that health care systems and providers must be prepared to obtain the most benefit from limited resources while mitigating harms to individuals, the health care system, and society. 39 references. Author abstract modified)
COVID-19; health services; standards; medical services; hospitals; PERSONAL PROTECTIVE EQUIPMENT; DISASTER RESPONSE; DISASTER PLANNING