Crisis Standards of Care

During disasters, we face limitations and challenges with the 4 S's of disaster (staff, stuff, structure/space, systems) to provide care for the large number of sick and injured patients. The usual standards to which we are accustomed to in daily practice must shift. The spectrum of care has three main categories.

1. Conventional- care is consistent with daily practice
2. Contingency- there is a shift from daily practice but care is functionally equivalent
3. Crisis- creative use and adaptation of available resources. Provision of care is sufficient but there is risk of poor outcomes

Typically, crisis standards of care if declared by the state government. At this time, there is no set criteria for declaring crisis standards of care.

Implementing crisis standards of care requires clear messaging to both healtchare staff and the community in order to maintain transparency and set expectations. Care provided should stirve to be fair, consistent, and equitable. Ethical and legal issues may arise when practicing at crisis standards of care and can be more magnified in the care of children.

This is a two-way arrow as when the situation improves, standards of care may gradually shift back towards conventional.

Further Reading:

• ASPR Tracie
• New England Journal of Medicine: Criteria for Declaring Crisis Standards of Care