Standards of Care in Catastrophic Emergencies

Abstract

Recent events, including the tragic earthquake in Haiti (2010), the devastating tsunami and radiation emergency in Japan (2011) and the threat of highly pathogenic, easily transmissible pandemic influenza, demonstrate that widespread loss of infrastructure combined with excessive demand for healthcare services will affect the ability to deliver medical care in a crisis and the quality of deliverable care. The intent of this chapter is to highlight the implications and impact that complex humanitarian emergency (CHE) and catastrophic disaster events will have on existing medical standards of care. Proactive planning for response in such austere environments will be required to limit ad hoc responses producing inconsistencies in the delivery of care and uncertain medical outcomes. Guidelines for how and when to make the difficult transition from individual-based outcomes – the focus of care in normal settings – to population-based outcomes that emphasize benefits to the greatest number will be examined. The context in which standards of care may be affected in a disaster medical response will be described. How will these change based upon whether they occur in developed, developing or failed states? In addition, planning guidance for catastrophic disaster response related to the allocation of scarce resources will also be discussed. This will include a description of a proposed framework for catastrophic response, including implementation of a healthcare surge capability response spectrum that delineates options for decision making in austere environments.