Abstract
The aim of this systematic review was to locate and analyze United States state crisis standards of care (CSC) documents to determine their prevalence and quality. Following PRISMA guidelines, Google search for "allocation of scarce resources" and "crisis standards of care (CSC)" for each state. We analyzed the plans based on the 2009 Institute of Medicine (IOM) report, which provided guidance for establishing CSC for use in disaster situations, as well as the 2014 CHEST consensus statement's 11 core topic areas. The search yielded 42 state documents, and we excluded 11 that were not CSC plans. Of the 31 included plans, 13 plans were written for an "all hazards" approach, while 18 were pandemic influenza specific. Eighteen had strong ethical grounding. Twenty-one plans had integrated and ongoing community and provider engagement, education, and communication. Twenty-two had assurances regarding legal authority and environment. Sixteen plans had clear indicators, triggers, and lines of responsibility. Finally, 28 had evidence-based clinical processes and operations. Five plans contained all 5 IOM elements: Arizona, Colorado, Minnesota, Nevada, and Vermont. Colorado and Minnesota have all hazards documents and processes for both adult and pediatric populations and could be considered exemplars for other states.
Highlights
The aim of this systematic review was to locate and analyze United States state crisis standards of care (CSC) documents to determine their prevalence and quality
S ince the terrorist attacks of 2001, the hurricane season of 2005, and the Ebola and COVID-19 outbreaks, significant resources have been used in the United States to improve the processes behind care provided in a disaster or pandemic
The term “crisis standards of care” (CSC) describes a substantial change in health-care operations and the level of care that can be delivered in a public health emergency, such as a pandemic or natural disaster.[1]
Summary
The aim of this systematic review was to locate and analyze United States state crisis standards of care (CSC) documents to determine their prevalence and quality. There are a variety of recommendations for specific topics available, such as disaster training for health-care professionals[3] and allocation of critical care resources.[2,4] These documents are realistic and frank about the change in level and type of care provided due to disaster limitations. Efforts have been made to develop formalized protocols for the allocation of scarce resources in the event of a pandemic or disaster. These documents are prescriptive in nature and are intended for use at multiple levels from the state down to the provider. Systematic Review of US State CSC Plans knowledge of these state documents and the processes needed to develop them
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