States work to hone health-crisis plans to use in catastrophes

Associated Press

ST. PAUL, MINN.

The scenarios are grim: A pandemic influenza swamps the availability of hospital ventilators. A chemical spill exhausts antidote supplies and decontamination abilities. A terror attack overwhelms ambulances and trauma centers. A big earthquake, wildfire or hurricane throws emergency rooms into crisis.

At the prodding of the federal government, state health departments nationwide are hurrying to complete “Crisis Standards of Care” plans to guide medical professionals in such catastrophes and determine what should trigger them.

It’s no easy task: Plan architects must navigate the ethical and legal minefields that would arise if there are more patients than providers at hospitals, clinics and other medical settings are set up to handle in usual fashion.

“When they are facing these decisions, the last thing you want to do is make it up as you go along,” said Dr. John Hick, an emergency physician at Hennepin County Medical Center in Minneapolis and a national expert in disaster planning. “Don’t leave this on the shoulders of the caregiver at the bedside.”

Major emergency-response planning isn’t new, but this process is focused on catastrophic events that would go beyond the ability of individual hospital systems to manage.

The Ebola outbreak that killed thousands in Africa and put about a dozen patients in U.S. hospitals focused new attention on the wider health system’s readiness to handle something so dramatic.

Closer to home, the examples used are Hurricane Katrina and the deadly 2011 tornado in Joplin, Mo.

Once a disaster such as those imagined by the planners is designated a crisis by a state official or a panel, care would shift from focusing on individual patients to sharing “limited resources” so that there are “best possible health outcomes for the population as a whole,” as described by the Institute of Medicine, a national advisory body.

That could mean people without acute conditions are denied hospital admission, scarce antiviral medicine is distributed more selectively, medical equipment is substituted with other devices and people judged unlikely to survive don’t get typical interventions.

At the request of federal agencies, the Institute of Medicine developed a framework to guide states in making their plans. Federal money tied to the effort sets a mid-2017 deadline for completion.

Hick said the public should be comforted that discussions of worst-case scenarios are occurring. But, he acknowledged, “it’s time-consuming planning for an event that may not happen.”