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Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report
Developing specific response measures forvulnerable populations and those with specialmedical needs, including pediatrics, geriatrics, and persons with disabilities.
Implementing robust situational awarenesscapabilities to allow for real-time informationsharing across affected communities and withthe “disaster medical advisory committee.”
The potential tragedy wrought by catastrophic disaster, whether naturally occurring or due to intentional acts, should serve as a clarion call to political leadership, policy makers, disaster planners, and the community at large to carefully plan for the allocation of scarce resources efficiently and fairly. Under circumstances in which demand for care exceeds supply, access to a broad continuum of healthcare resources—including those required for life-sustaining intervention—may be curtailed. Disaster events may challenge the depth of human, materiel, and intellectual resources required to respond to them. A highly pathogenic pandemic, detonation of a nuclear weapon, destructive earthquake, or severe hurricane could each pose challenges to the delivery of health care beyond the “imaginable.” For this reason, it is imperative that as a nation, we consider our response to such events, ensuring that the processes we use to triage the delivery of care meet the highest ethical standards, and are based on the humanitarian imperative that “all possible steps should be taken to prevent or alleviate human suffering arising out of…calamity, and that civilians so affected have a right to protection and assistance” (The Sphere Project, 2004). In addition, while all populations remain vulnerable to catastrophic events particular populations remain more vulnerable than others. These populations—as described in the committee’s report—should be given particular attention to make sure their unique needs are considered in disaster planning and response efforts. As such, the Committee supports the efforts of the World Health Organization and similar agencies in affirming the importance of addressing health inequities and the social determinants of health because those most vulnerable in communities prior to a disaster are those most likely to be impacted adversely by the disaster itself (WHO, 2008).