Crisis Standards of Care

Statement by Dr. Nicole Lurie, HHS Assistant Secretary for Preparedness and Response on the IOM Letter Report: Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations released Sept. 24, 2009

We appreciate the efforts of the Institute of Medicine in developing this national guidance. States, communities, and hospitals can use this guidance to establish and implement standards of care specifically for disaster situations – both naturally occurring and manmade – under scare resource conditions.

While the current influenza pandemic is not expected to reach the catastrophic level we recognize the need to prepare for a public health emergency of any type in which an overwhelming number of people suddenly seek and require medical care in communities across the United States.

HHS turned to the IOM to provide independent, evidence-based expert advice in this important area. In a catastrophic situation, families, clinicians and policy makers could face difficult decisions about how to best care for patients. Patients will need the best care possible given the resources at hand. At the same time, members of the community will need reassurance that decisions are fair and transparent and our nation will need reassurance that policies and protocols within and across states are consistent and that citizens and stakeholders are included and heard.

The IOM guidance provides a solid basis on which planners can establish standards of care before a catastrophic disaster occurs so that as a nation, the United States is prepared. These recommendations include sample strategies to address resource shortages, indicators and triggers for crisis standards of care including for disaster mental health, possible indicators of crisis capacity, and characteristics of reactive and proactive triage.

We commend the IOM for its recognition of the role that community engagement and communication play in building resilience. Individual, family, and community resilience may have a direct bearing on reducing the surge demand on the health care system and will be critical to a community's ability to recover should crisis standards of care need to be implemented in a disaster situation.

We hope that agencies and organizations at every level that care for patients will use the IOM guidance so that, as a nation, we have a consistent approach for patient care in catastrophic situations.

Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations