Elizabeth (Izzy) Montgomery, MPA
In this installment in our series explaining key terms and phrases used by public health officials in discussions of the COVID-19 pandemic, we look at the phrase “crisis standards of care.”
As the fourth wave of the COVID-19 pandemic continues in the U.S., hospital bed and staffing shortages have been reported in many Southern states, including Arkansas, Mississippi, Louisiana, and Florida. As these resources become strained, hospital systems may be forced to make difficult decisions regarding which patients receive care. These hard choices may be made based on adjusted standards known as “crisis standards of care.”
The Institute of Medicine defines crisis standards of care as “a substantial change in usual healthcare operations and level of care it is possible to deliver, which is made necessary by a pervasive (e.g. pandemic influenza) or catastrophic (e.g. earthquake, hurricane) disaster.” Ultimately, crisis standards of care are intended to achieve the best outcome for a broader group of patients rather than an individual patient under extenuating circumstances. A formal declaration by a state government of the necessity to move to crisis standards of care provides legal and regulatory protections for healthcare workers who are charged with allocating limited medical resources during an ongoing crisis period.
Last summer, the Arizona Department of Health Services authorized crisis standards of care within the state’s hospital system, allowing for statewide triage protocols when the demand for healthcare exceeded the ability to provide normal standards of care. The triage plan provided guidance to healthcare workers on which patients to treat when resources became scarce. This was the only point in the state’s history that it made a declaration of crisis standards of care, and Arizona was the first and only state so far to enact these standards during the COVID-19 pandemic.
With the fourth wave of the pandemic severely impacting states in the Southeastern U.S., however, that may soon change. In Louisiana, one of the hardest-hit states in the current COVID surge, there has been discussion of the need for crisis standards of care in some hospitals. In a recent interview with a Baton Rouge hospital, a physician who helped to develop the state’s crisis standards of care guidelines described those guidelines as “the worst possible step.” The guidelines outline how the state’s hospitals, when overwhelmed by a crisis, should triage patients and determine what patients should be admitted and turned away.
As the pandemic continues to severely limit hospital resources in states experiencing a surge in COVID-19 cases, efforts to increase low vaccination rates in these states and encourage other public health mitigation efforts are critical.