This forthcoming article comprehensively reviews existing state crisis standards of care (CSC) guidelines based on guidance from the 2009 Institute of Medicine (IOM) Report and 2014 CHEST consensus statement. The authors conclude that 5 state plans include all 5 key elements from the IOM report (Arizona, Colorado, Minnesota, Nevada, and Vermont), and that 2 of these (Colorado and Minnesota) could be considered exemplars for other states.
The authors located 31 publicly available state CSC plans, 13 of which adopted an “All Hazards” and 18 of which were written specifically in relation to pandemic influenza. The article highlights noteworthy aspects of several state plans in addition to the comprehensive global review.
Based on the 2009 report by the IOM (now part of the National Academies of Science, Engineering and Medicine), the authors reviewed CSC plans for 5 specific elements. Of the 31 state CSC plans, the authors conclude that:
- 18 have strong ethical grounding
- 21 have integrated and ongoing community and provider engagement, education, and communication
- 22 have assurances regarding legal authority and environment
- 16 have clear indicators, triggers, and lines of responsibility, and
- 28 have evidence-based clinical processes and operations.
Only 5 state plans included all 5 IOM elements. The authors conclude that Indiana’s 2014 plan “thoroughly examine[s] ethical issues with triage and scarce resources, but [does] not explore any other ethical issues.” They separately note that Indiana’s plan focuses on critical care including resource allocation, but does not contain a section on indicators, triggers, or lines of authority.
