Horrific COVID-19 surge demands readiness on crisis standards of care

Timothy M. Smith , Contributing News Writer

What’s the news: Hospitals across most of the U.S. are seeing huge surges in COVID-19 patients, and many intensive care units either are over capacity or will be in the coming weeks. The AMA and seven other national organizations have issued a joint statement calling for readiness to quickly implement crisis standards of care to meet the surge and protect the health care system from functional collapse.

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Clear and decisive steps to limit the spread of COVID-19 are needed to protect staff and ease patients' fears about seeking care during pandemic.

Crisis standards of care are implemented when shortages in health care resources—such as clinical staff, hospital beds and medications—are so severe that conventional standards and processes are no longer sufficient.

“We call on governors, health departments, hospitals and other health care sector partners to act immediately to be prepared to implement crisis standards of care,” says the statement, developed by the National Academy of Medicine. These stakeholders “all have a duty to prepare so that the death toll is as small as possible and clinicians are not forced to make agonizing decisions in a vacuum without guidance, training or a considered process.”

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Other signatories to the statement are the American Nurses Association, Association of American Medical Colleges, American Association of Colleges of Nursing, National Council of State Boards of Nursing and the National League for Nursing, and the Johns Hopkins Bloomberg School of Public Health Center for Health Security.

Why it’s important: Hospitals are having to take drastic measures to accommodate the surge, such as canceling admissions and nonemergency procedures, transferring patients to neighboring jurisdictions and setting up alternate care sites. The nationwide COVID-19 surge threatens to aggravate inequities in care quality and outcomes.

“We have reached a point in the crisis at which critical decisions must be made in order to do the most good possible for the largest number of people with limited resources,” the statement says.

There are specific actions for governors, state health departments and hospitals and health systems to support, plan for and equitably implement crisis standards of care. These include regulatory relief, regional patient “load balancing,” planning for staffing shortages and exploring the use of telehealth services.

“Failure to act,” the statement warns, “will inevitably mean more lives lost, lasting damage to our fragile health care system and deepened scars of health inequity.”

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Learn more: The AMA has created an ethics resource page, “Crisis standards of care: Guidance from the AMA Code of Medical Ethics,” that offers expert guidance on allocating scarce resources during a pandemic. Drawing on numerous opinions from the Code, the page provides a comprehensive guide to help organizations ensure responsibility to patients during pandemics.

Also, stay informed and updated with the AMA’s resources on COVID-19 and vaccine development.