Crisis standards of care impacts all patients, not just COVID patients

Color codes assigned to patients under the Crisis Standards of Care plan.

By Ruth Brown, Idaho Reports

If crisis standards of care are implemented in Idaho, anyone seeking medical care at a hospital could be affected, not just coronavirus patients. 

Crisis standards of care are implemented in extreme circumstances in which there are more people in need of health care than there are resources available to help everyone. It sets up a framework for health care workers to prioritize how to use resources and who to help first.

The Idaho Crisis Standards of Care plan “will be activated during disaster situations in which usual standards of care are not possible due to scarcity of resources, and it is necessary to balance the needs of the community with the needs of individuals.”

The term “resources” can apply to hospital space, staff, patient beds, medical supplies and other forms of resources.

The care plan, adopted in 2020 in response to the COVID-19 pandemic, outlines a variety of scenarios in which care would change at hospitals.

“During a disaster, when healthcare resources are overwhelmed, (crisis standards of care) will be adopted to maximize the number of lives saved. Decision-makers, medical providers, and medical practitioners must focus on doing the most good for the greatest number of people based on available health resources,” the plan states. 

The plan also takes into consideration the ethical standards for health care workers. The ethical guidance includes accountability, consistency, duty to care, duty to steward resources, proportionality, and transparency. The principals are intended to apply to patient care, equitable resource allocation, professional and legal standards, communications, and other response operations.

HOW IT’S TRIGGERED

To request a crisis standards of care designation, a hospital or group of hospitals must make a formal request for resources to the state. They must show that they have exhausted all other possible resources and avenues to deal with an abnormal influx of patients, and cannot transfer patients to other facilities. They must also demonstrate that healthcare delivery across the system is consistently impacted — not just emergency services, but surgeries and other treatments that have to be be delayed because staff and resources are reassigned.

The request goes to Idaho Department of Health and Welfare. The State of Idaho Disaster Medical Advisory Committee, or SIDMAC, considers the request. Ultimately, the IDHW director makes the decision on whether to activate crisis standards.

HOW IT WORKS

  • Patients are assessed when they arrive at the hospital and coded by a color or number evaluating what the likelihood of their survival is and how emergent their need for care is. This assesses things such as whether a patient needs immediate care versus whether they are stable and can be treated with a prescription. It also accounts for scenarios such as whether the patient needs a single service, like an X-ray, or if they need multiple services with a time-critical problem. The needs and likelihood for survival are what help health care workers determine which patients get immediate care and who must wait for health care.
  • The sickest patients may receive only comfort care and not lifesaving interventions. 
  • The hospital will continue to reassess patients. Some patients may have their resources, like beds or ventilators, reassigned to other patients with a higher likelihood of survival. Other patients may be upgraded and given more treatment if resources allow.
  • For EMS teams, the plans around their response can change. They may need to decline response to calls without evident potential threat to life, or EMS may use non-certified dispatch personnel to handle incoming emergent calls, according to the plan. 
  • For outpatient services, some services would be deferred entirely, such as physical therapy. Hospitals may be forced to adapt services and venues for cardiac or stroke rehab and cancer therapy to minimize the risk of exposure to COVID-19. They may also convert conference rooms or classrooms to patient care areas.
  • For surgical services, hospitals could defer surgeries not essential to preserve life and those  not needed to facilitate discharge from hospital. Staff that is normally used in surgery may be reassigned to more emergent care services.

On Aug. 24, Department of Health and Welfare Director Dave Jeppesen said the state is “dangerously close” to declaring crisis standards of care in some areas. 

Idaho Reports will continue to follow Idaho’s hospital capacity status.

Melissa Davlin contributed to this report.

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