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Disasters and public health emergencies can stress health care systems to the breaking point and disrupt delivery of vital medical services. During such crises, hospitals and long-term care facilities may be without power; trained staff, ambulances, medical supplies and beds could be in short supply; and alternate care facilities may need to be used. Planning for these situations is necessary to provide the best possible health care during a crisis and, if needed, equitably allocate scarce resources. Crisis Standards of Care: A Toolkit for Indicators and Triggers examines indicators and triggers that guide the implementation of crisis standards of care and provides a discussion toolkit to help stakeholders establish indicators and triggers for their own communities. Together, indicators and triggers help guide operational decision making about providing care during public health and medical emergencies and disasters. Indicators and triggers represent the information and actions taken at specific thresholds that guide incident recognition, response, and recovery. This report discusses indicators and triggers for both a slow onset scenario, such as pandemic influenza, and a no-notice scenario, such as an earthquake. Crisis Standards of Care features discussion toolkits customized to help various stakeholders develop indicators and triggers for their own organizations, agencies, and jurisdictions. The toolkit contains scenarios, key questions, and examples of indicators, triggers, and tactics to help promote discussion. In addition to common elements designed to facilitate integrated planning, the toolkit contains chapters specifically customized for emergency management, public health, emergency medical services, hospital and acute care, and out-of-hospital care.
Problems contacting emergency services and delayed assistance are not unusual when incidents occur in rural areas, and the consequences can be devastating, particularly with mass casualty incidents. The IOM's Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop to examine the current capabilities of emergency response systems and the future opportunities to improve mass casualty response in rural communities.
Catastrophic disasters occurring in 2011 in the United States and worldwide-from the tornado in Joplin, Missouri, to the earthquake and tsunami in Japan, to the earthquake in New Zealand-have demonstrated that even prepared communities can be overwhelmed. In 2009, at the height of the influenza A (H1N1) pandemic, the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, along with the Department of Veterans Affairs and the National Highway Traffic Safety Administration, asked the Institute of Medicine (IOM) to convene a committee of experts to develop national guidance for use by state and local public health officials and health-sector agencies and institutions in establishing and implementing standards of care that should apply in disaster situations-both naturally occurring and man-made-under conditions of scarce resources. Building on the work of phase one (which is described in IOM's 2009 letter report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations), the committee developed detailed templates enumerating the functions and tasks of the key stakeholder groups involved in crisis standards of care (CSC) planning, implementation, and public engagement-state and local governments, emergency medical services (EMS), hospitals and acute care facilities, and out-of-hospital and alternate care systems. Crisis Standards of Care provides a framework for a systems approach to the development and implementation of CSC plans, and addresses the legal issues and the ethical, palliative care, and mental health issues that agencies and organizations at each level of a disaster response should address. Please note: this report is not intended to be a detailed guide to emergency preparedness or disaster response. What is described in this report is an extrapolation of existing incident management practices and principles. Crisis Standards of Care is a seven-volume set: Volume 1 provides an overview; Volume 2 pertains to state and local governments; Volume 3 pertains to emergency medical services; Volume 4 pertains to hospitals and acute care facilities; Volume 5 pertains to out-of-hospital care and alternate care systems; Volume 6 contains a public engagement toolkit; and Volume 7 contains appendixes with additional resources.
During a wide-reaching catastrophic public health emergency or disaster, existing surge capacity plans may not be sufficient to enable health care providers to continue to adhere to normal treatment procedures and follow usual standards of care. This is a particular concern for emergencies that may severely strain resources across a large geographic area, such as a pandemic influenza or the detonation of a nuclear device. Under these circumstances, it may be impossible to provide care according to the standards of care used in non-disaster situations, and, under the most extreme circumstances, it may not even be possible to provide basic life sustaining interventions to all patients who need them. Although recent efforts to address these concerns have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. This workshop summary highlights the extensive work that is already occurring across the nation. Specifically, the book draws attention to existing federal, state, and local policies and protocols for crisis standards of care; discusses current barriers to increased provider and community engagement; relays examples of existing interstate collaborations; and presents workshop participants' ideas, comments, concerns, and potential solutions to some of the most difficult challenges.
Emergency Medical Services (EMS) agencies regardless of service delivery model have sought guidance on how to better integrate their emergency preparedness and response activities into similar processes occurring at the local, regional, State, tribal, and Federal levels. This primary purpose of this project is to begin the process of providing that guidance as it relates to mass care incident deployment.
The most comprehensive resource of its kind, Ciottone's Disaster Medicine, 2nd Edition, thoroughly covers isolated domestic events as well as global disasters and humanitarian crises. Dr. Gregory Ciottone and more than 200 worldwide authorities share their knowledge and expertise on the preparation, assessment, and management of both natural and man-made disasters, including terrorist attacks and the threat of biological warfare. Part 1 offers an A-to-Z resource for every aspect of disaster medicine and management, while Part 2 features an exhaustive compilation of every conceivable disaster event, organized to facilitate quick reference in a real-time setting. Quickly grasp key concepts, including identification of risks, organizational preparedness, equipment planning, disaster education and training, and more advanced concepts such as disaster risk reduction, tactical EMS, hazard vulnerability analysis, impact of disaster on children, and more. Understand the chemical and biologic weapons known to exist today, as well as how to best manage possible future events and scenarios for which there is no precedent. Be prepared for man-made disasters with new sections that include Topics Unique to Terrorist Events and High-Threat Disaster Response and Operational Medicine (covering tactical and military medicine). Get a concise overview of lessons learned by the responders to recent disasters such as the earthquake in Haiti, Hurricane Sandy, the 2014 Ebola outbreak, and active shooter events like Sandy Hook, CT and Aurora, CO. Learn about the latest technologies such as the use of social media in disaster response and mobile disaster applications. Ensure that everyone on your team is up-to-date with timely topics, thanks to new chapters on disaster nursing, crisis leadership, medical simulation in disaster preparedness, disaster and climate change, and the role of non-governmental agencies (NGOs) in disaster response - a critical topic for those responding to humanitarian needs overseas. Expert Consult eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices.
This is the definitive reference on disaster medicine, outlining areas of proficiency for health care professionals handling mass casualty crises.
This book gathers a selection of peer-reviewed papers presented at the International Conference on Operations Research (OR 2019), which was held at Technische Universität Dresden, Germany, on September 4-6, 2019, and was jointly organized by the German Operations Research Society (GOR) the Austrian Operations Research Society (ÖGOR), and the Swiss Operational Research Society (SOR/ASRO). More than 600 scientists, practitioners and students from mathematics, computer science, business/economics and related fields attended the conference and presented more than 400 papers in plenary presentations, parallel topic streams, as well as special award sessions. The respective papers discuss classical mathematical optimization, statistics and simulation techniques. These are complemented by computer science methods, and by tools for processing data, designing and implementing information systems. The book also examines recent advances in information technology, which allow big data volumes to be processed and enable real-time predictive and prescriptive business analytics to drive decisions and actions. Lastly, it includes problems modeled and treated while taking into account uncertainty, risk management, behavioral issues, etc.
Most experts define a mass casualty event (MCE) as a natural (e.g., earthquake, pandemic) or manmade (e.g., detonation of a nuclear device, conventional explosive, bioterror attack) incident that suddenly or progressively generates large numbers of injured and/or ill people who require medical and/or mental health care. The magnitude of demand for medical care resources has the potential to vastly outstrip the ability of a health care facility or a local, regional, or national public health and health care delivery system to deliver medical care services consistent with generally established standards of care. The scope and complexity of an MCE can severely challenge even the most highly experienced and well-equipped health care providers and systems. By definition, an MCE generates a level of demand for health care resources that outstrips available supply. Under those circumstances, local and regional health care providers are unable to meet victims' needs at the level normally expected of a modern health care delivery system. Because such situations are difficult to predict and can occur with little or no warning, health care systems and providers must be prepared to swiftly implement contingency plans to reduce less-urgent demand for health care services; optimize the use of existing resources; and secure additional resources, if possible, from backup sources. If these measures are insufficient to meet demand, providers may be forced to shift from the traditional treatment approach, which strives to deliver optimum care to every patient, to one that seeks to do the most good for the most people with the available resources. This latter concept has come to be known as “crisis standards of care.” The Institute of Medicine (IOM) Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations published a landmark Letter Report recommending that health care providers, organizations, government officials, and the public approach the challenge in a thoughtful and proactive way, anchored in four values: fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. The IOM Letter Report also recommended that State plans incorporate, among other things, evidence-based clinical processes and operations. To help Federal, State, and local policymakers, providers, and interested members of the public address the issue with the best available evidence, we were asked to build on the work of the IOM and previous reviews by conducting a thorough review of the evidence regarding allocation of scarce medical resources during MCEs. This report addresses the following Key Questions: Key Question 1. What current or proposed strategies are available to policymakers to optimize the allocation and management of scarce resources during MCEs? What outcomes are associated with these strategies? What factors act as facilitators or barriers to their implementation or effectiveness? Key Question 2. What current or proposed strategies are available to providers to optimize the allocation of scarce resources during MCEs? What outcomes are associated with these strategies? What factors are identified as facilitators or barriers to their implementation or effectiveness? Key Question 3. What are the public's key perceptions and concerns regarding the development and implementation of strategies to allocate and manage scarce resources during actual and potential MCEs? Key Question 4. What current or proposed methods are available to engage providers in discussions regarding the development and implementation of strategies to allocate and manage scarce resources, both in planning for and during an MCE? What outcomes are associated with these strategies? What factors are identified as facilitators or barriers to engaging providers in these discussions?