A: As many places see a significant surge in COVID-19 cases, hospitals and resources become strained. Crisis standards of care represent a big change from usual healthcare made necessary by a major disaster.
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 COVID-19 patients, many are again 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, hospitals 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 This could include determining what care might be offered or when care may need to be withdrawn.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. Many hospitals in Arizona, for example, were unable to give anyone else ECMO (an advanced life support system for the heart and lungs that can be used for the very sickest of COVID-19 patients) in December because of the surge. This also means that care is impacted for all people, not just people who have COVID-19. Anyone who needs healthcare could find their care impacted.
Is this fair and who decides what these standards are?
Each state develops their own crisis standards of care guidelines (you can 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 COVID-19 pandemic has disproportionally affected populations that have already been economically, socially, and medically marginalized and has worsened health inequities. Crisis standards are prohibited from prioritizing resources based on factors like race, disability, age, gender identify, 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: wear a high-quality mask, GET VACCINATED AND BOOSTED, stay in fresh air or well-ventilated areas, avoid large crowds, stay home when sick and get tested. Of course, if you are having an emergency, do not hesitate to go to the hospital.
Stay safe out there. Take care of yourself and each other.
Those Nerdy Girls
Links:
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
