ated with establishing standards of care; guidance on standards of care in medical triage events; changing roles and responsibilities of healthcare workers under contingency and crisis standards of care; guidance on legal, ethical, and practical issues in setting standards of care in declared emergencies; and identifying triggers. The committee does seek to make clear that the extraordinary time constraints significantly limited the opportunity to consider more evidence and enlist other stakeholders in the deliberations process. This is particularly true given the complexity and importance of the issues being considered. This letter serves as a summary of the committee’s conclusions and recommendations. Greater detail can be found in the relevant report text that follows this letter.

Through a careful review of available protocols, the committee recognizes that although some federal, state, municipality, territorial, and health-sector agencies and institutions have made considerable progress in developing protocols, many states have only just begun to address this urgent need. Furthermore, there is a need to develop all protocols around the same key elements and components to ensure coordination, consistency, and fair allocation of scarce resources during a disaster.

In the development of its national guidance on standards of care, the committee was asked to consider if there should be a single national guidance or scenario-specific guidance. Based on a review of the currently available state standards of care protocols, published literature, and testimony provided at its workshop, the committee concluded that there is an urgent and clear need for a single national guidance for states for crisis standards of care that can be generalized to all crisis events and is not specific to a certain event. However, the committee recognizes that within the single general framework, individual disaster scenarios may require specific considerations, such as differences between no-notice events versus slow-onset events, but that the key elements and components remain the same.

The committee was tasked to develop national framework guidance on the key elements that should be included in standards of care protocols for disaster situations. Ethical norms in medical care do not change during disasters – health care professionals are always obligated to provide the best care they reasonably can under given circumstances. For purposes of developing recommendations for situations when healthcare resources are overwhelmed, the committee defines the level of health and medical care capable of being delivered during a catastrophic event as crisis standards of care.

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