Alternate Standards of Care in Mass Casualty Events

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Alternate Standards of Care in Mass Casualty
Events

• Patrick OCarroll, MD, MPH
• Regional Health AdministratorPublic Health
  Service Region X

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The bad news
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Not a lot of there there. --Gertude Stein
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The good news
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Good work is under way

• AHRQ document, Altered Standards of Care in Mass
  Casualty Events
• Soon to be released Providing Mass Medical Care
  with Scarce Resources A Community Planning Guide
• Under way Various working groups developing
  guidance for specific issues

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Altered Standards of Care in Mass Casualty Events

• August 2004 AHRQ/OASPHEP meeting
• Bioethics, emergency medicine, emergency
  management, health administration, health law and
  policy, public health
• Purpose
• Examine how current standards of care might need
  to be altered in response to a mass casualty
  event
• Identify needs for planning, guidance, and tools
  and issues to be addressed
• Recommend actions to address needs of Federal,
  State, regional, community, and health systems
  planners

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Altered Standards of Care in Mass Casualty
Events Key Findings

• Goal of response to a mass casualty event
  maximize the number of lives saved.
• Changes in the usual standards of health and
  medical care will be required
• Many health system preparedness efforts do not
  provide sufficient planning and guidance
  concerning the altered standards of care
• Protocols for triage need to be flexible enough
  to change as the size of a mass casualty event
  grows

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Altered Standards of Care in Mass Casualty
Events Key Findings (contd)

• The basis for allocating medical resources in a
  mass casualty event must be fair and clinically
  sound process for making these decisions should
  be transparent and judged by the public to be
  fair
• Plan should take into account factors common to
  all hazards as well as hazard-specific factors
• Plans should ensure an adequate supply of
  qualified providers who are trained specifically
  for a mass casualty event

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Altered Standards of Care in Mass Casualty
Events Key Findings (contd)

• Nonmedical issues that affect the delivery of
  care need to be addressed including
• The authority to activate or sanction the use of
  altered standards of care under certain
  conditions.
• Legal issues related to liability, licensing, and
  intergovernmental or regional mutual aid
  agreements.
• Financial issues related to reimbursement and
  other ways of covering medical care costs.
• Issues related to effective communication with
  the public.
• Issues related to populations with special needs.
• Issues related to transportation of patients.

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Altered Standards of Care in Mass Casualty
Events Key Findings (contd)

• Guidelines and companion tools are needed by
  preparedness planners at every level
• This finding ? Recommended action
• Develop a Community-Based Planning Guide for Mass
  Casualty Care to assist preparedness planners in
  their efforts.

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Altered Standards of Care in Mass Casualty Events
http//www.ahrq.gov/research/altstand/
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Providing Mass Medical Care with Scarce
Resources A Community Planning Guide

• Purpose to provide community planners with
  information and insights that will help them in
  their efforts to plan for and respond to a mass
  casualty event (MCE).

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Providing Mass Medical Care with Scarce
Resources A Community Planning Guide

• Process again a collaboration of OASPHEP and
  AHRQ, co-editors of the Guide
• Leading experts identified
• Series of papers commissioned to address six
  critical fields related to mass casualty care
• Discussed by a broader group of experts at a
  meeting held in Washington, DC, June 2006

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Providing Mass Medical Care with Scarce
Resources A Community Planning Guide

• Will provide info on
• The circumstances that communities likely would
  face as a result of a MCE
• Key constructs, principles, and structures to be
  incorporated in the planning for a MCE
• Approaches and strategies to provide the most
  appropriate standards of care possible under the
  circumstances
• Examples of tools and resources that are
  available to help in planning process
• Examples of how certain health systems,
  communities, or States have approached certain
  issues as part of their MCE-related planning
  efforts.

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Six Critical Fields Related To Mass Casualty Care

• Ethical Considerations in Community Disaster
  Planning
• Assessing the Legal Environment Concerning MCE
  Planning and Response
• Prehospital Care
• Hospital/Acute Care
• Alternative Care Sites
• Palliative Care

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Providing Mass Medical Care with Scarce
Resources A Community Planning Guide

• The Guide is to be released in a matter of
  weeks/months (wending its way through
  clearance)
• In the meantime
• Sally Phillips, R.N., Ph.D.
• Director, Bioterrorism Preparedness Research
  Program
• Center for Primary Care, Prevention, and Clinical
• Partnerships
• Agency for Healthcare Research and Quality
• U.S. Department of Health and Human Services

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Under way Various working groups developing
guidance for specific issues

• Meeting now to develop guidance at the level of
  procedures, protocols, algorithms, etc.
• Prehospital Care
• Hospital/Acute Care
• Alternative Care Sites
• Palliative Care
• Due date for guidance delivery

?
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Additional Contacts

• Dennis Zaenger, MPH (lead on the Guide project)
• Project Manager, AHRQ Knowledge Transfer Project
• Health Systems Research, Inc.
• 1200 - 18th Street, NW - Suite 700
• Washington, DC 20036
• Main 202-828-5100
• dzaenger_at_hsrnet.com ?
• Deborah A. Levy, CDC/NCID/DHQP
• Mailstop A07
• Atlanta GA 30329-4018
• 404.639.4086
• deborah.levy_at_cdc.hhs.gov

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Alternate Standards of Care in Mass Casualty
Events

• Patrick OCarroll, MD, MPH
• Regional Health AdministratorPublic Health
  Service Region X