Activity

Guidance for Establishing Standards of Care for Use in Disaster Situations

Type:

Consensus Study

Topic(s):

Health Care Workforce, Health Services, Coverage, and Access, Public Health, Quality and Patient Safety

Board(s):

Board on Health Sciences Policy

Activity Description

In response to a request from the HHS Office of the Assistant Secretary of Preparedness and Response, the Institute of Medicine has convened an ad hoc committee to conduct a 2-phase activity on standards of care for use in disaster situations. The committee is focusing attention on developing guidance to establish standards of care that should apply to disaster situations--both naturally-occurring and man-made--where there are scarce resources. Ethical principles will be incorporated into the standards.

Phase 1:

An ad hoc committee of the Institute of Medicine (IOM) conducted a study and issued a letter report to the Assistant Secretary of Preparedness and Response. The letter report provided guidance on standards of care for use in disaster situations. Specifically the committee has: 

• Developed preliminary framework guidance that identifies and describes the key elements that should be included in disaster standards of care protocols.
• Identified potential triggers that can be used by state and local public health officials to develop standards of care protocols that will assist healthcare providers.
• Developed a template matrix that can be used by state and local public health officials as a framework for developing specific guidance for healthcare providers to develop disaster standards of care.
• Considered roles and responsibilities of various stakeholders in the implementation of the guidance.
• Considered mechanisms for integrating the views of the general public and healthcare providers in the development and implementation of the guidance.

The report letter identifies triggers that indicate a need to change from normal standards to disaster standards. Disaster standards will consider approaches to conserving, substituting, adapting and doing without resources. The committee was not be responsible for establishing, creating, or defining standards of care.

The committee also commissioned a paper to provide background to the committee deliberations that examined the key elements in existing state and local standards of care protocols and the impact of allocation schemes on disaster standards, and proposed framework guidance for national disaster standards that can be applied to H1N1 response for the coming fall flu season. In addition, the commissioned paper explored issues related to the implementation of standards of care protocols including legal considerations. The committee based its recommendations on currently available policies, protocols, published literature, and other available guidance documents and evidence, as well as its expert judgment.

Phase 2:

Phase 2 of the project will prepare a report that will update the preliminary guidance developed in phase 1. The expanded guidance will be based on a series of stakeholder input activities. During this phase the committee will seek input and comment from individuals who used the guidance developed in phase I. In addition the committee will organize and host a series of data gathering activities focused on the provider community and the public (e.g., local civic organizations, leaders from faith-based groups, educators) that would allow an opportunity to provide comment on the guidance developed in phase 1. The expanded report will include considerations about triggers that apply to changes in the standards of care and approaches to conserving, substituting, adapting and doing without resources. In addition, the committee will develop guidance that will include information for healthcare providers from primary care, home health, community health centers, and other provider communities not traditionally engaged.