Health Systems & Supply Strategies

This article by Warrington et al. traces the path followed by health systems in Vermont to address supply chain constraints that initially limited crucial testing supplies and restricted ability to scale up COVID-19 testing early in the pandemic. A state university academic medical center and medical school partnered with the state health department, a private health system, and providers across the state to address these challenges, including creating in-house collection kits, reassigning staff with reduced workloads to participate, and coordinating supply utilization through mutual agreement among hospital laboratory directors, managers, and providers to order only as needed and avoid stockpiling. Vermont was among a small number of states (9) to meet testing targets as of November 2020, illustrating the success of the approach. The article offers a retrospective, descriptive study of the operational efforts involved that provides important insights for planning and preparedness efforts in other states to address future public health emergencies.

Health Care Workers & Psychological Help

 This article by Hooper et al. is a systematic review of studies of early interventions to protect frontline health care workers from psychological harm. The review identified 12 relevant studies describing 6 interventions: psychological first aid, eye movement desensitization and reprocessing, and trauma risk management showed effectiveness in at least 2 studies each. Resilience and coping for the health care community; anticipate, plan, and deter; and resilience at work programs showed promising results in 1 study each. The paper provides additional information and external links to details regarding each type of program. The authors conclude that despite the limited available evidence, several interventions appeared potentially suitable and useful for improving psychological functioning among HCWs across a variety of disaster situations. These psychological concerns have been particularly relevant due to the significant burdens on frontline HCWs during the COVID-19 pandemic, and multiple analyses have identified stress and burnout as critical problems for HCWs that have been exacerbated during the pandemic due to infection fears for self and others, persistent PPE access problems, and other stressors.

Crisis Standards of Care & Liability Protection

 This article by Koch & Hoffman discusses potential legal liability for following crisis standards of care (CSC) plans and argues that limited liability protections for health care professionals operating under such conditions and following established CSC plans are justified by reliance on the ethical principle of reciprocity. Clinicians, institutions, and policymakers have all expressed concern about potential liability for following CSC plans, which set out how to make difficult decisions regarding triage or allocation of other scarce medical resources during a widespread emergency that prevents adherence to nonemergency standards of care. A majority of states grant civil liability protections to physicians providing care in a public health emergency, and many of these laws are expansive. The authors argue that these protections are necessary but may be too broad. There is a lack of data on how CSC plans impact behavior (i.e., whether plans will be followed in difficult circumstances), in part because few states have formally adopted CSC plans and even fewer have actually activated them in response to an emergency. The authors make the case for limited liability protections under the principle of reciprocity, which holds generally that “society should provide assistance to individuals and communities who act for the benefit of society when doing so might be to their detriment.” In a poignant example, the authors explain that under a CSC plan, a physician might be directed to remove a patient from a ventilator without the patient’s consent to provide it to another patient with higher likelihood of survival, which represents a significant societal demand on the physician with the potential for severe psychological trauma. Liability shields, they argue, are an appropriate and proportionate response to that demand. The legal standard of care will provide a successful defense for a physical in many such situations due to its consideration of surrounding circumstances; however, immunity provides greater protection by reducing or eliminating the need to defend against a potential lawsuit.