Crisis Standards Of Care Research Articles

Burn Surge Capacity: Recognizing the Catastrophe Phase in Crisis Standards of Care.

Burn Surge Capacity: Recognizing the Catastrophe Phase in Crisis Standards of Care.

Ethics: Crisis Standards of Care Simulation.

Ethical dilemmas exist with decision-making regarding resource allocations, such as critical care, ventilators and other critical equipment, and pharmaceuticals during pandemics. Triage artificial intelligence (AI) algorithms based on prognostication tools exist to guide these decisions; however, implicit bias may affect the decision-making process leading to deviation from the algorithm recommendations. Conflict within the ethical domain may be affected as well. A knowledge gap was identified within the Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) curriculum regarding ethics in crisis standards of care (CSC) medical decision-making. Incorporating a CSC simulation looked to address this knowledge gap. A simulation-based learning (SBL) experience was designed as a critical access setting where CSC are in place and three diverse, medically complex patients in need of critical care present to the hospital where one critical care bed remains open. Given the complexity of the simulation scenario, a table-top pilot test was selected. Three AG-ACNP fourth-quarter students in their critical care rotation volunteered for the pilot test. Students were provided with the topic, "ethics crisis standards of care" and the article, "A catalogue of tools and variables from crisis and routine care to support decision-making during pandemics" by M. Cardona et al. (2021), to read in advance. Students were provided with the triage AI algorithm (M. Cardona et al., 2021) utilizing prognostication tools to prioritize which patient requires the critical care bed. The expectation was that implicit bias would enter the decision-making process, causing deviation from the triage AI algorithm and moral distress. The debriefing session revealed that students deviated from the triage AI algorithm, experienced implicit bias, moral distress, and utilized clinical judgment and experience to care for all three patients. The pilot test results support that a CSC SBL experience addresses a critical knowledge gap in AG-ACNP education and an SBL experience incorporating ethical decision-making curriculum with standardized patients should be developed and trialed as the next step.

Investigating ethical tradeoffs in crisis standards of care through simulation of ventilator allocation protocols.

Arguments over the appropriate Crisis Standards of Care (CSC) for public health emergencies often assume that there is a tradeoff between saving the most lives, saving the most life-years, and preventing racial disparities. However, these assumptions have rarely been explored empirically. To quantitatively characterize possible ethical tradeoffs, we aimed to simulate the implementation of five proposed CSC protocols for rationing ventilators in the context of the COVID-19 pandemic. A Monte Carlo simulation was used to estimate the number of lives saved and life-years saved by implementing clinical acuity-, comorbidity- and age-based CSC protocols under different shortage conditions. This model was populated with patient data from 3707 adult admissions requiring ventilator support in a New York hospital system between April 2020 and May 2021. To estimate lives and life-years saved by each protocol, we determined survival to discharge and estimated remaining life expectancy for each admission. The simulation demonstrated stronger performance for age-sensitive protocols. For a capacity of 1 bed per 2 patients, ranking by age bands saves approximately 29 lives and 3400 life-years per thousand patients. Proposed protocols from New York and Maryland which allocated without considering age saved the fewest lives (~13.2 and 8.5 lives) and life-years (~416 and 420 years). Unlike other protocols, the New York and Maryland algorithms did not generate significant disparities in lives saved and life-years saved between White non-Hispanic, Black non-Hispanic, and Hispanic sub-populations. For all protocols, we observed a positive correlation between lives saved and life-years saved, but also between lives saved overall and inequality in the number of lives saved in different race and ethnicity sub-populations. While there is significant variance in the number of lives saved and life-years saved, we did not find a tradeoff between saving the most lives and saving the most life-years. Moreover, concerns about racial discrimination in triage protocols require thinking carefully about the tradeoff between enforcing equality of survival rates and maximizing the lives saved in each sub-population.

Crisis Standards of Care and Triage: Medico-Legal Conundrums

Crisis Standards of Care and Triage: Medico-Legal Conundrums

Impact of Surge Strain and Pandemic Progression on Prognostication by an Established COVID-19–Specific Severity Score

IMPORTANCE: Many U.S. State crisis standards of care (CSC) guidelines incorporated Sequential Organ Failure Assessment (SOFA), a sepsis-related severity score, in pandemic triage algorithms. However, SOFA performed poorly in COVID-19. Although disease-specific scores may perform better, their prognostic utility over time and in overcrowded care settings remains unclear. OBJECTIVES: We evaluated prognostication by the modified 4C (m4C) score, a COVID-19–specific prognosticator that demonstrated good predictive capacity early in the pandemic, as a potential tool to standardize triage across time and hospital-surge environments. DESIGN: Retrospective observational cohort study. SETTING: Two hundred eighty-one U.S. hospitals in an administrative healthcare dataset. PARTICIPANTS: A total of 298,379 hospitalized adults with COVID-19 were identified from March 1, 2020, to January 31, 2022. m4C scores were calculated from admission diagnosis codes, vital signs, and laboratory values. MAIN OUTCOMES AND MEASURES: Hospital-surge index, a severity-weighted measure of COVID-19 caseload, was calculated for each hospital-month. Discrimination of in-hospital mortality by m4C and surge index-adjusted models was measured by area under the receiver operating characteristic curves (AUC). Calibration was assessed by training models on early pandemic waves and measuring fit (deviation from bisector) in subsequent waves. RESULTS: From March 2020 to January 2022, 298,379 adults with COVID-19 were admitted across 281 U.S. hospitals. m4C adequately discriminated mortality in wave 1 (AUC 0.779 [95% CI, 0.769–0.789]); discrimination was lower in subsequent waves (wave 2: 0.772 [95% CI, 0.765–0.779]; wave 3: 0.746 [95% CI, 0.743–0.750]; delta: 0.707 [95% CI, 0.702–0.712]; omicron: 0.729 [95% CI, 0.721–0.738]). m4C demonstrated reduced calibration in contemporaneous waves that persisted despite periodic recalibration. Performance characteristics were similar with and without adjustment for surge. CONCLUSIONS AND RELEVANCE: Mortality prediction by the m4C score remained robust to surge strain, making it attractive for when triage is most needed. However, score performance has deteriorated in recent waves. CSC guidelines relying on defined prognosticators, especially for dynamic disease processes like COVID-19, warrant frequent reappraisal to ensure appropriate resource allocation.

Building flexible data structure for disaster response.

Recent years have had repeated public health emergencies where communities are to take the lead in response. Yet official data systems rarely can support community decision-making with real or near-real time, localised data. This disconnect discourages evidence-based decision-making based on community need, leading instead to highly contested, and often erratic decisions. Develop a plan for public health and communities together to develop, understand and use real (or near real) time data during a public health emergency, including roles and activities for public health, community decision-makers and community members. Focus is primarily on communities without access to 'in-house' dedicated data providers. Using 'crisis standards of care' and the National Planning Frameworks, a set of actions are proposed to build the data infrastructure for public health disaster response, focused on local data needs. The proposed actions are organised within the 'crisis standards of care' five key elements framework. These actions are then connected to the Public Health Accreditations Board (PHAB) domains and the public health professionals core competencies demonstrating where these proposed actions fit in the services and skills of public health organizations and professionals. Many of the proposed actions would be applicable to larger more resourced communities and public health disaster responses. Forward planning, practicing and discussions based in the ''crisis standards of care'' model and 'The National Planning Frameworks' could help communities build the relationships needed to access data for decision-making in the moment. Further, using the ''crisis standards of care'' model would allow for development of a process and framework for rapidly shifting needs and resource access as is seen in emergencies. Model would also increase transparency and community focus, assisting decision-makers in advocating and implementing the response in timely and equitable manner which would increase positive outcomes and positively engage the community.

Using a Comprehensive On-Site Assessment Process to Reduce Central Line-Associated Bloodstream Infection Rates.

Central line-associated bloodstream infection (CLABSI) rates increased substantially in the United States following the emergence of COVID-19 and subsequent surges. The pandemic resulted in hospital capacities being exceeded and crisis standards of care being implemented for sustained periods. As COVID-19 rates in the United States began to stabilize, some facilities did not return to previous CLABSI rates, indicating a change in practices that had a longer-term impact on CLABSI prevention. The authors' large health care system observed similar increases in CLABSI following the emergence of COVID-19, prompting investigation and intervention in the form of a quality improvement project. To identify changes related to ongoing increases in CLABSI, an assessment team conducted standardized on-site assessments at 11 facilities. Site assessments were considered an intervention, as they involved rigorous preassessment investigations and interviews, case reviews, practice observations, on-site staff interviews, and postassessment support for additional interventions. Nine facilities had enough postassessment data to analyze the impact of intervention. The overall CLABSI rate (infections per 1000 line days) at the 9 facilities in the 6 months prior to intervention was 1.42, and the postassessment rate in the 6 months following intervention was 0.44. This indicates the effectiveness of facility-specific investigation followed by targeted performance improvements to reduce the rate of CLABSI.

765 When All Hell Breaks Loose: The Need for Specialized Burn Provider Expertise During Crisis

Abstract Introduction The COVID-19 pandemic prompted health care organizations to create or revisit crisis standards of care (CSC) guidelines. The goal of these plans is to preemptively determine the most effective way to allocate resources under circumstances in which not all patients can be treated in accordance with general standards of care. In 2020, the American Burn Association (ABA) released professional recommendations for the development of CSC guidelines. Specifically, the ABA provided triage tables that could be incorporated into organizational CSC guidelines with the intention of assisting providers by predicting mortality based on a patient’s age and burn size. These tables are often misinterpreted by non-burn providers who tend to overestimate burn size and conclude that a patient has a higher predicted mortality than they actually do. Inaccurate predicted mortalities can result in inappropriate care plans and ultimately impact patient outcomes. We argue that the ABA predicted mortality tables are helpful when used by experienced burn providers, but that there are inherent ethical risks when they are utilized by providers who lack appropriate burn care experience. Methods We conducted a literature review of CSC guidelines that included specific instructions for the triage of burn patients. We reviewed 15 publicly available CSC guidelines, 8 of which specifically mentioned burn patients, and examined each to see if/how they utilized ABA triage tables for predicting burn patient mortality. Results Of the 8 CSC plans that acknowledged burn patients, 5 utilized the mortality predictors outlined in the ABA triage tables to guide resource allocation. In the majority of plans, patients with a predicted mortality of >90% were not eligible to receive treatment and/or transfer. None of the plans specified the involvement of a specialized burn provider in assessing burns. Conclusions Our findings indicate that the expert evaluation of burns and thus predicted mortality can be the difference between receiving and not receiving potentially life-saving interventions under CSC guidelines. If a non-burn provider overestimates a burn size, for example, a patient may be undertreated for potentially survivable injuries under some CSC guidelines. This may further perpetuate health disparities given vulnerable populations are at higher risk of suffering burn injuries and often face a higher risk of morbidity and mortality. Applicability of Research to Practice This project demonstrates the need for expert input from specialized burn providers in assessing burns, especially in CSC scenarios, to ensure these assessments are reliable and accurate. Involving expert burn providers in this process will help ensure ethically appropriate clinical care decisions are being made which will improve patient outcomes and resource management in crises and decrease provider distress.

Implementing Crisis Standards of Care in the Intensive Care Unit: A Scoping Review

Introduction:Disasters have the potential to cause a surge of patients, some of which may require admission to an intensive care unit (ICU). Due to the high resource requirements of ICUs, normal standards of care may need to be altered to treat more people with limited resources, a care model referred to as crisis standards of care (CSC). The pragmatic implementation of CSC in ICUs due to patient surges from disasters has not been well explored in the literature.Method:This scoping review guided by the Joanna Briggs institute methodology for scoping reviews searched medical databases including CINHAL, PubMed, ProQuest and SCOPUS. Articles were included if they reflected on the actual implementation of CSC delivered in ICU as a result of a patient surge from a disaster. Quantitative data was extracted into tables and qualitative content was thematically analyzed.Results:A total of 17 papers were included in the review. The disaster event that dominated the results was COVID-19. Most papers relayed subjective accounts of how care models were impacted by patient surges. Common themes included the repurposing of other clinical areas to accommodate ICU patients, resource shortages (particularly ventilators) and staff shortages. Moral strain was felt when processes such as palliation and treatment modality were altered due to resource restrictions.Conclusion:This review highlights the dearth of high-quality research in implementing CSC in ICUs. Understanding the pragmatic experiences of CSC shows not only the logistical insufficiencies that have been experienced, but the moral and clinical repercussions that these insufficiencies have caused. Inadequate preparation for future disasters, particularly short notice disasters, may lead to further implementation of CSC resulting in poorer outcomes for patients and detrimental impacts on healthcare workers. More research into the practical application of CSC in ICU may help mitigate the impact of patient surges from disasters.

The Impact of COVID-19 Patient Surges on the Burn Care System

Introduction:Burn mass casualty incident (BMCI) planning efforts have been in practice and publication for 40+ years. While COVID-19 has no direct connection to burn injuries, the impact of COVID-19 on the healthcare system including burn care was and remains significant.Method:A retrospective analysis of data was conducted voluntarily submitted to the American Burn Association from March 2020 to June 2021 which generally coincides with the first three waves of the pandemic. We focused on the self-reported data specific to the three critical components in managing a surge of patients: staffing, space, and supplies (to include pharmaceuticals and equipment).Results:Staff: These data were collected over a period that coincided with the first three waves seen in the USA. Staffing shortages were noted during each of the surges but were most excessive when a regional surge paralleled surges in other parts of the country (November-December 2020).Space: Late November and early December 2020, space was in short supply with the surge of patients for more of the region than at any other time during the 28 weeks of reporting. While single facilities reported other episodes of limited space or supplemented with temporary structures, the peak was early December.Supplies: As the first surge began to subside, the supply shortages were abated. However, as additional surges occurred; the supply chain had not recovered. Supply shortages were reported in greater numbers than either space or staffing needs through the multiple waves of the pandemic.Conclusion:The COVID-19 pandemic directly led to a diminished available capacity for burn care in such a way that it compromised the ability to confront a surge of burn-injured patients. Future BMCI planning efforts must consider this aspect of the process. Crisis Standards of Care may come into play during such an event.

Lessons From COVID-19 for the Next War: Crisis Standards of Care in the Role 3 Intensive Care Unit.

The rationing of medical resources became a common practice during the SARS-CoV-2 (COVID-19) pandemic. To cope with overwhelming patient numbers, hospitals were forced to adopt "crisis standards of care" (CSC) guidelines, which allow physicians to navigate the task of rationing health care resources in both an effective and ethically sound manner. The Military Health System currently has clinical guidelines for mass casualty incident (MCI) triage but lacks deployed Role 3 intensive care unit (ICU) CSC guidelines. In future peer and near-peer conflicts, this gap may prove detrimental when thousands of casualties following a single battle create a continuous and prolonged mass casualty event. The challenges of providing critical care in a battlefield hospital during a large conflict are unique and numerous, but lessons from COVID-19 ICUs such as transitioning to a utilitarian ethic, clear definitions, decision points, and decision authorities, as well as the establishment of clinical practice guidelines formulated from evidence-based protocols, can better prepare the U.S. expeditionary medical force for future conflicts. A battlefield CSC will allow military critical care physicians and nurses to manage overwhelmed ICUs and make better triage decisions, allowing them to provide a higher quality of care to the collective. In this commentary, we explore the need for Wartime CSC in the battlefield Role 3 ICU and the tools and methods used by civilian and military institutions to create and enact CSCs throughout the COVID-19 pandemic.

Catastrophic COVID-19 Delta Variant Surge in French West Indies: Report of an ICU Triage Policy.

Here, we report the management of a catastrophic COVID-19 Delta variant surge, which overloaded ICU capacity, using crisis standards of care (CSC) based on a multiapproach protocol. Retrospective observational study. University Hospital of Guadeloupe. This study retrospectively included all patients who were hospitalized for COVID-19 pneumonia between August 11, 2021, and September 10, 2021, and were eligible for ICU admission. Based on age, comorbidities, and disease severity, patients were assigned to three groups: Green (ICU admission as soon as possible), Orange (ICU admission after the admission of all patients in the Green group), and Red (no ICU admission). Among the 328 patients eligible for ICU admission, 100 (30%) were assigned to the Green group, 116 (35%) to the Orange group, and 112 (34%) to the Red group. No patient in the Green group died while waiting for an ICU bed, whereas 14 patients (12%) in the Orange group died while waiting for an ICU bed. The 90-day mortality rates were 24%, 37%, and 78% in the Green, Orange, and Red groups, respectively. A total of 130 patients were transferred to the ICU, including 79 from the Green group, 51 from the Orange group, and none from the Red group. Multivariate analysis revealed that among patients admitted to the ICU, death was independently associated with a longer time between ICU referral and ICU admission, the Sequential Organ Failure Assessment score, and the number of comorbidities, but not with triage group. CSC based on a multiapproach protocol allowed admission of all patients with a good prognosis. Higher mortality was associated with late admission, rather than triage group.

Differences in US Regional Healthcare Allocation Guidelines During the COVID-19 Pandemic.

Hospitals faced unprecedented scarcity of resources without parallel in modern times during the COVID-19 pandemic. This scarcity led healthcare systems and states to develop or modify scarce resource allocation guidelines that could be implemented during "crisis standards of care" (CSC). CSC describes a significant change in healthcare operations and the level of care provided during a public health emergency. Our study provides a comprehensive examination of the latest CSC guidelines in the western region of the USA, where Alaska and Idaho declared CSC, focusing on ethical issues and health disparities. Mixed-methods survey study of physicians and/or ethicists and review of healthcare system and state allocation guidelines. Ten physicians and/or ethicists who participated in scarce resource allocation guideline development from seven healthcare systems or three state-appointed committees from the western region of the USA including Alaska, California, Idaho, Oregon, and California. All sites surveyed developed allocation guidelines, but only four (40%) were operationalized either statewide or for specific scarce resources. Most guidelines included comorbidities (70%), and half included adjustments for socioeconomic disadvantage (50%), while only one included specific priority groups (10%). Allocation tiebreakers included the life cycle principle and random number generators. Six guidelines evolved over time, removing restrictions such as age, severity of illness, and comorbidities. Additional palliative care (20%) and ethics (50%) resources were planned by some guidelines. Allocation guidelines are essential to support clinicians during public health emergencies; however, significant deficits and differences in guidelines were identified that may perpetuate structural inequities and racism. While a universal triage protocol that is equally accepted by all communities is unlikely, the lack of regional agreement on standards with justification and transparency has the potential to erode public trust and perpetuate inequity.

What COVID-19 Can Teach Nurses About Liability Risks.

The COVID-19 pandemic has raised questions about professional liability risks for nurses tasked with caring for large numbers of severely ill patients while also challenged by resource shortages. This article will explore some key liability issues associated with the pandemic, including immunity, documentation, crisis standards of care, delegation and assignment, scope of practice, floating, travel nursing, telehealth, and misinformation and social media.

The theoretical and practical arguments against the unilateral withdrawal of life-sustaining treatment during crisis standards of care: Does the Knobe effect apply to unilateral withdrawal?

Some argue that it is ethically justifiable to unilaterally withdraw life-sustaining treatment during crisis standards of care without the patient's consent in order to reallocate it to another patient with a better chance of survival. This justification has been supported by two lines of argument: the equivalence thesis and the rule of the double effect. We argue that there are theoretical issues with the first and practical ones with the second, as supported by an experiment aimed at exploring whether the Knobe effect, which affects the folk concept of intention, applies to situations of unilateral withdrawal. Fifty-two critical care physicians from one university were asked to ascribe intention in two hypothetical scenarios A and B in which outcomes differ-the patient from whom life-sustaining treatment is withdrawn dies in scenario A but survives in scenario B-but the intention, to save the other patient regardless of the outcome of the other, is the same. The survey was administered via a web-based survey and all answers were anonymous. A paired proportion test was used to compare responses to both questions. All 52 surveyed individuals responded in scenario A and 30 (57.7%) ascribed intention when outcomes were unfavorable, whereas 50 responded in scenario B and 8 (16%) ascribed intention when outcomes were favorable, a difference that was statistically significant (p < 0.001). There are theoretical and practical issues with the arguments proposed to justify the unilateral withdrawal of life-sustaining treatment based on the equivalence thesis and the rule of double effect.

The Lifeboat at World's End: Moving Beyond Crisis Standards of Care.

It may be too late to avoid the climate crisis, likely to be humanity's most expensive, widespread, and enduring catastrophe. This is a qualitatively different kind of catastrophe, in which increased costs, decreased revenue, and no possibility of bailout force communities to harshly cut budgets, especially in health care. Little is known about making such brutal cuts fair or efficient, nor how to help the public accept them. The crisis presents an opportunity for bioethicists to play a crucial role, but one for which traditional approaches are inherently inadequate. Although often dismissed as heartless, Garrett Hardin's "lifeboat ethics" started a conversation about making ethical choices in global disasters-where all options are painful and unacceptable-and may provide guidance. Bioethics during the climate crisis must focus on communities rather than individuals and help survivors grieve the terrible consequences. Because today's choices will affect many generations, with the burdens falling most heavily on poor communities, we have to construct a radical bioethics to help tomorrow's health care become green, efficient, and fair.

What the American Journal of Critical Care Junior Peer Reviewers Were Reading During Year 2 of the Program.

The American Journal of Critical Care's Junior Peer Reviewer program aims to mentor novice reviewers in the peer review process. To grow their critical appraisal skills, the participants take part in discussion sessions in which they review articles published in other journals. Here we summarize the articles reviewed during the second year of the program, which again focused on the care of critically ill patients with COVID-19. This article aims to share these reviews and the reviewers' thoughts regarding the relevance, design, and applicability of the findings from the selected studies. High rates of delirium associated with COVID-19 may be impacted by optimizing sedation strategies and allowing safe family visitation. Current methodology in crisis standards of care may result in inequity and further research is needed. The use of extracorporeal carbon dioxide removal to facilitate super low tidal volume ventilation does not improve 90-day mortality outcomes. Continued research to better understand the natural history of COVID-19 and interventions useful for improving outcomes is imperative.

Crisis standards of care within the first wave of the COVID-19 pandemic.

The ability of the healthcare infrastructure to overcome overwhelming needs during a crisis or disaster with equitable care stems from the implementation of crisis standards of care (CSC). CSC provides a framework for the discussion and planning of how to adapt care to meet these needs, while focusing on the greatest good for the greatest number. The COVID-19 pandemic has challenged healthcare infrastructure, but no formal CSC declaration or disclosure to the public within the first wave of the COVID-19 pandemic leads to the need for further inquiry surrounding the planning and implementation for CSC. This research evaluates data and inferential indicators related to CSC implementations from public documents in Brazil, India, Italy, and New York State during the first wave of the COVID-19 pandemic. Were there mitigation methods that could be implemented prior to the need for CSC? Are there policy and decision-making implications to CSC? Lastly, how does CSC relate to changes in mortality during a pandemic, especially with the phenomena surrounding excess mortality? While CSC were not openly implemented by any nation or state in the first wave of the COVID-19 pandemic, CSC principle use of expanding capacity to non-clinical areas, need for healthcare workers, critical supply lacking, and excess mortality, along with healthcare collapse for India and Brazil can be gleaned from the data. Acknowledging a strain on healthcare infrastructure and the need for CSC implementation allows for the community to respond as a whole to better ensure that care remains equitable.

Avoiding Crisis Conditions in the Healthcare Infrastructure: 2 Case Studies in Statewide Collaboration.

In fall 2020, COVID-19 infections accelerated across the United States. For many states, a surge in COVID-19 cases meant planning for the allocation of scarce resources. Crisis standards of care planning focuses on maintaining high-quality clinical care amid extreme operating conditions. One of the primary goals of crisis standards of care planning is to use all preventive measures available to avoid reaching crisis conditions and the complex triage decisionmaking involved therein. Strategies to stay out of crisis must respond to the actual experience of people on the frontlines, or the "ground truth," to ensure efforts to increase critical care bed numbers and augment staff, equipment, supplies, and medications to provide an effective response to a public health emergency. Successful management of a surge event where healthcare needs exceed capacity requires coordinated strategies for scarce resource allocation. In this article, we examine the ground truth challenges encountered in response efforts during the fall surge of 2020 for 2 states-Nebraska and California-and the strategies each state used to enable healthcare facilities to stay out of crisis standards of care. Through these 2 cases, we identify key tools deployed to reduce surge and barriers to coordinated statewide support of the healthcare infrastructure. Finally, we offer considerations for operationalizing key tools to alleviate surge and recommendations for stronger statewide coordination in future public health emergencies.

Rapid implementation of a medical student rotation in health systems operations and remote patient care in response to COVID-19

ABSTRACT Medical schools initially removed students from clinical rotations at the outset of COVID-19 for safety reasons when students were eager to help and health systems needed personnel. In response, we rapidly implemented an innovative 2-week rotation for medical students to participate in health systems operations and care through remote efforts including triage and resource allocation. The curriculum also contained online self-paced educational modules covering topics including ethics, crisis standards of care, and modeling. As the health system needs shifted, so too did learners’ work. One hundred and twenty-five 3rd and 4th-year students completed the experience over 10 months. Learner satisfaction, confidence, and knowledge assessed through pre- and post-rotation surveys showed statistically significant and educationally meaningful improvement. A near uniform change greater than 1 point (on a 5-point scale) was demonstrated upon rotation completion. Blending health systems and educational structures to meet the needs of both creates unique opportunities to educate students in new ways.