As new threats from pandemic influenza join ever-present risks of earthquakes, hurricanes, or bioterrorism, the Institute of Medicine (IOM) has issued new recommendations to guide health professionals during emergencies or catastrophic events.
The IOM report, compiled at the request of the US Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response, emphasizes the need for state and local public health departments and health care facilities to establish consistent standards of crisis care in the event of disasters that could sicken or injure thousands of individuals.
“In a public health emergency, dedicated professionals will not have the capacity to deliver” their usual high standards of care, said Lawrence O. Gostin, JD, chair of the IOM committee that produced the report. “The health care system will collapse without a rational plan that includes ethical allocation of limited resources and that is seen by the public as transparent and fair.”
The committee defined crisis standards of care as a substantial change in usual health care operations and levels of care provided when a disaster overwhelms the health care system and resources become scarce. Its recommendations offer national guidance that states can apply to all types of crises rather than specific events.
According to the report, state governments would declare crisis standards to be in effect when conditions justify changes in operations. State officials are urged to develop standards that are ethical, include community and professional education and communication, have a clearly defined chain of command, and use evidence-based clinical processes.
Implementation of crisis standards should be consistent among neighboring states and should integrate the US Department of Defense, the Veterans Health Administration, and the Indian Health Service medical facilities into planning and response efforts. Also, crisis standards should provide legal protection for clinicians and other practitioners involved in disaster care.
Even though many states have made substantial progress in recent years in developing disaster response plans, some public health organizations say health departments already are stretched to their limits.
The Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials sent letters last spring to Congressional appropriations committees explaining that state and local health departments have neither adequate staff nor funding to respond in the event of a prolonged pandemic of 2009 influenza A(H1N1).
ASTHO Executive Director Paul Jarris, MD, has said that state, county, and city budget shortfalls have resulted in the loss of 11 000 public health workers in the past year. Jarris added that additional layoffs are expected through the rest of this year, and that states do not have dedicated public health emergency reserve funds from which to draw.
The report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, is available online at http://www.nap.edu/catalog.php?record_id=12749.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.