1. Alternate Standards of Care in Mass Casualty Events Patrick O’Carroll, MD, MPH Regional Health Administrator Public Health Service Region X

2. The bad news

3. Not a lot of “there” there. --Gertude Stein

4. The good news

5. 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 20,000 ft5,000 ft~Sea level

6. 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

7. 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

8. Altered Standards of Care in Mass Casualty Events: Key Findings (cont’d) 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

9. Altered Standards of Care in Mass Casualty Events: Key Findings (cont’d) 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.

10. Altered Standards of Care in Mass Casualty Events: Key Findings (cont’d) 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.

11. Altered Standards of Care in Mass Casualty Events http://www.ahrq.gov/research/altstand/

12. 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).

13. 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

14. 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.

15. 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

16. 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

17. Under way: Various working groups developing guidance for specific issues Meeting now to develop guidance at the level of procedures, protocols, algorithms, etc.: 1.Prehospital Care 2.Hospital/Acute Care 3.Alternative Care Sites 4.Palliative Care Due date for guidance delivery: ?

18. 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@hsrnet.com ? Deborah A. Levy, CDC/NCID/DHQP Mailstop A07 Atlanta GA 30329-4018 404.639.4086 deborah.levy@cdc.hhs.gov

19. Alternate Standards of Care in Mass Casualty Events Patrick O’Carroll, MD, MPH Regional Health Administrator Public Health Service Region X