Yesterday, the Pennsylvania Department of Health (DOH) released interim guidelines to help health care professionals, clinics, and facilities triage and provide care during pandemic and disaster situations when patient needs may overwhelm health care resources. The purpose of the interim guidelines is to “provide a framework for responding to a catastrophic event and the challenges it brings to personnel, resources, and treatment decisions.” The interim guidelines have an ethical foundation based on fairness, consistency, proportionality, transparency, and solidarity. On this foundation, the interim guidelines provide guidance on developing plans, training personnel, and implementing strategies to deal with constrained medical resources resulting from a crisis.
Developed along with the Hospital & Healthsystem Association of Pennsylvania, the interim guidelines represent an early version of what a steering committee, having convened last year, intended to release nearer to April 2021. The onset of the COVID-19 pandemic caused the DOH to fast-track its “work in progress” while emphasizing that the interim version is likely to change in the future. Along with that emphasis, the DOH encouraged hospitals to modify the interim guidelines as necessary to meet their own needs and abilities.
According to the Institute of Medicine, a crisis standard of care, such as that proposed by the interim guidelines, is “a change in usual health care operations and the level of care it is possible to deliver, which is made necessary by a pervasive (e.g., pandemic influenza) or catastrophic (e.g., earthquake, hurricane) disaster.” In light of this, the objective of the guidelines, including in their current interim format, is to provide a “means to mount a response to an incident that far exceeds the usual health and medical capacity and capabilities of a medical community.”
According to the interim guidelines, Pennsylvania has 154 acute care hospitals with a total of about 35,000 licensed beds, of which about 11% are intensive care beds. In the context of a pandemic such as the one we now face, the interim guidelines note that while the spread from state to state may give Pennsylvania some time to prepare for a surge of patients at these hospitals, the nationwide effect of such a spread would mean that federal assistance would be severely limited. Facilities must therefore take proactive steps to address the likely scarcity in health care resources so that they can provide patients with a typical level of care for as long as possible.
The interim guidelines define different scopes of application including situations involving both statewide and geographically-limited circumstances. They describe both the individual efforts of facilities complying with their own emergency operations plans and the coordination among facilities, government agencies, and regional health care coalitions to communicate about appropriate local response efforts. The guidelines also provide a graphic representation of how a hospital may react to the progression of a disaster and when in that progression the hospital would shift to the crisis standards of care set forth in the interim guidelines.