Manual Considerations for a Catastrophic Declaration: Issues and Analysis

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There have even been some attempts to conflate discussion of disaster standards of care with tort reform, which is disingenuous at best and dangerous at worst, because it discourages honest discussion and planning. Conditions such as those created during the aftermath of Hurricane Katrina will necessitate involvement of all available healthcare personnel responsible for doing whatever they can under extraordinarily trying circumstances.

They must know that their decisions and the care they delivered will not be subject to legal scrutiny in a retrospective assessment, provided those decisions and actions were taken in the context of a declared disaster and within the accepted framework of local, regional, and state catastrophic disaster response efforts. All attempts at distortion of the issue aside, though, a handful of states and regions have taken important steps to prepare for such eventualities by establishing legal protections for healthcare providers.

Virginia is one of the states at the vanguard. In , its government adopted one of the most comprehensive statewide legal approaches, with legislative language that explicitly offers protection to healthcare providers who respond to disasters:. Legal protections similar to those approved by the state of Virginia ought to be introduced in and adopted by every state legislature. Local and regional healthcare planners and responders need to know that state authorities are supportive and protective of their efforts to deliver health care during catastrophes.

Moreover, as recommended in the IOM report, achieving state- to-state consistency is of utmost importance. This will not be easy in a federalized system, but it is not impossible, and it is an important goal. When disaster strikes, the statutory authority for federal response to a disaster, including mobilization of resources and funding of the response and recovery efforts, is derived from the Stafford Act. This law is intended to provide federal support to state and local governments in their response to a crisis.

There are policy discussions under way regarding the relevance and adequacy of Stafford Act declarations in truly catastrophic situations. However, current discussions are incomplete without the inclusion of language that both specifically recognizes the implementation of crisis standards of care under catastrophic response conditions and clarifies liability protections for healthcare providers and facilities that are compelled to respond under such conditions. Consideration for passage of an amendment to the Stafford Act cannot be based solely on damage estimate costs.

It must reflect the reality that in the worst-case scenarios, it will not be possible to deliver medical care as we know it. Healthcare providers will do the very best with what they have available to them, but hard decisions will have to be made regarding who gets care and what kind of care can be delivered. It must be understood that, despite all best efforts and noble intentions, patients may not receive and should not expect to receive the care they get under normal, day-to-day circumstances.

And healthcare providers must be supported in their efforts to do the best possible for the most number of patients, given the resources available to them. In short, there will be desperate actions taken in desperate circumstances, and the nation must face that reality now and start addressing the issues at hand. Definition of standard of care. Accessed August 24, Agency for Healthcare Research and Quality.

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Improving the Nation's Response to Catastrophic Disasters

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You already recently rated this item. This report examines concerns expressed by policymakers and experts that current Stafford Act declarations are inadequate to respond to, and recover from, highly destructive events. It presents the arguments for and against amending the act to add a catastrophic declaration amendment. This report also includes data analyses of past and potential disasters to determine what incidents might be deemed as catastrophic, and explores alternative policy options that might obviate the need for catastrophic declarations.

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