Following publication of the 2009 letter report, ASPR, the Department of Veterans Affairs, and the National Highway Traffic Safety Administration requested that the IOM reconvene the committee to conduct phase two of the study, which involved building on that report, examining its impact, and developing templates to guide the efforts of individuals and organizations responsible for CSC planning and implementation. The committee also was charged with identifying metrics to assess the development of crisis standards of care protocols and developing a set of tools for use at the state and local levels in engaging the public as a necessary step in the development of CSC plans.
REPORT DESIGN AND ORGANIZATION
This report has a functional format and design that reflect its purpose of providing a resource manual for all stakeholders involved in a disaster response. It is organized as a series of stand-alone resources for ease of use and reference. The first volume includes Chapters 1 through 4. Chapter 1 provides an introduction to the report, including a summary of key elements of CSC identified in the committee’s 2009 letter report, the recommendations from that report, and discussion of the report’s impact as essential context for phase two of the committee’s work. The next three chapters establish a framework for a systems approach to the development and implementation of CSC plans (Chapter 2), and address the legal issues (Chapter 3) and the ethical, palliative care, and mental health issues (Chapter 4) that agencies and organizations at each level of a disaster response should address.
The next four chapters are bound as separate volumes, each aimed at a key stakeholder group—state and local governments (Chapter 5), emergency medical services (EMS) (Chapter 6), hospitals and acute care facilities (Chapter 7), and out-of-hospital and alternate care systems (Chapter 8). The text of the chapters defines the roles and responsibilities of these stakeholders, describes operational considerations associated with their development and implementation of CSC plans, and provides brief descriptions of templates that outline the specific functions and tasks for each stakeholder when allocating scarce resources in response to a disaster. The templates are easily located at the end of each chapter by the red bar that runs the length of each page.
Chapter 9, again published as a separate volume, includes a brief description of the committee’s work to design the public engagement toolkit and the tools themselves.1
The final volume of the report consists of six appendixes: a glossary of terms used in the report (Appendix A), a sample hospital CSC plan (Appendix B), a listing of potentially scarce medical resources (Appendix C), a listing of resource challenges by disaster type (Appendix D), the committee’s statement of task (Appendix E), and biographical sketches of the committee members (Appendix F).
FRAMEWORK FOR A SYSTEMS APPROACH TO CRISIS STANDARDS OF CARE
CSC are just one aspect of broader disaster planning and response efforts; they are a mechanism for responding to situations in which the demand on needed resources far exceeds the resources’ availability. A systems