A: As many places see a significant surge in COVID19 cases, hospitals and resources become strained. Crisis standards of care represent a big change from usual healthcare made necessary by a major disaster.
➡️So, what does that actually mean?
Crisis standards help guide decisions that must be made in extreme scarcity of resources (including staff, stuff, and space). Crisis standards of care can include changes in how healthcare systems are run, how care is delivered, and what treatment options are offered. The goal is to stretch limited resources to help the most people.
➡️What does this mean for hospitals?
As hospitals see surges of COVID19 patients, many are already making dramatic changes to normal operating procedures. This includes canceling nonemergency procedures, moving patients to other hospitals or sometimes even across state lines, training or moving staff to work in areas they don’t normally work in, and setting up “surge hospitals” or units that do not typically house patients (like in cafeterias and classrooms).
➡️Does this mean rationing care?
In the worst-case scenario, clinicians may be asked to make tough decisions about life saving care. This could include determining what care might be offered or when care may need to be withdrawn. The goal is to save as many lives as possible, recognizing that some individuals may die who would have otherwise survived. This is essentially war time medicine, and a place no one wants to be. Los Angeles hospitals are so overwhelmed, for example, LA is working to conserve medical oxygen and asking ambulances not to bring people to the hospital if their hearts stopped and they weren’t able to restart them on the scene.
➡️Is this fair and who decides what these standards are?
Each state develops their own crisis standards of care guidelines (you can usually find your state’s crisis standards at their public health website). States decide which provisions are activated and under what circumstances. Not every change may need to be implemented all at once. That depends on what is going on locally.
While these standards guide decisions to meet the needs of their communities, each plan should consider key ethical principles: fairness, balancing a duty to a patient and the community, transparency in decision making, consistency, accountability and equity. The Institute of Medicine and many health organizations published guidance on what is considered ethical when implementing crisis standards of care.
We know that the COVID19 pandemic has disproportionally affected minority populations and worsened health disparities. Crisis standards are prohibited from prioritizing resources based on factors like race, disability, age, gender, and wealth.
➡️What can I do to help?
These are hard discussions and really scary to think about. Thankfully, there are things we can do every day to avoid the worst: keep your distance from other people, wear a mask, stay in fresh air or well-ventilated areas, restrict socializing, and keep time with others short. And, when it is your turn, get vaccinated! Of course, if you are having an emergency, do not hesitate to go to the hospital.
There is a lot to cover on Crisis Standards of Care. You can find more info at the links below:
AAMC Crisis Standards of Care FAQ
HHS Collection of Crisis Standards of Care Info
Example of state crisis standards of care for Arizona
AMA Crisis Standards of Care Code of Medical Ethics
