Crisis Standards of Care

Allocating limited medical resources in crisis situations

Stranded without power in a city under water and devastated by Hurricane Katrina, doctors and nurses at Memorial Hospital in New Orleans were forced to make critical decisions about how to allocate medical resources when there were not enough to save every patient. Who gets the limited seats on evacuation helicopters? Who should have access to the last ventilator? The wake of Hurricane Katrina and other such catastrophic disasters has sparked efforts across the country to clarify how to make these traumatic, sometimes life-and-death decisions in emergency situations. Many states are working to develop Crisis Standards of Care, guidelines for administering medical care and allocating resources in these extreme crisis situations.

To inform the development of separate Crisis Standards of Care in Maryland, Illinois, and Washington State, RESOLVE has led extensive community engagement processes, holding public meetings in diverse communities throughout each state to explore residents’ values and perspectives on the issue. These meetings gave participants safe, structured space to weigh in on factors such as whether priority care should be given to certain groups of patients and what they saw as “fair” in such situations. These community engagement efforts emphasized inclusion of diverse perspectives across ethnicity, age, and religion as well as across urban and rural communities. They stand as a model for deliberative public engagement in the development of value-laden public policy.

Health and government officials in Maryland, Illinois, and Washington State are each in the process of determining how the input received through these facilitated meetings will factor into the development and implementation of their own respective Crisis Standards of Care.