Response Resource Availability and
Crisis Standards of Care

Resource continuum: Normal Good Fair/Poor
Operating conditions:Normal/usual operating conditions, with normal "space, staff, and supplies" Care functionally equivalent to normal but with constrained resources Austere operating conditions: care with insufficient "space, staff, and/or supplies"
Response resource adequacySpace Usual patient care space fully utilized —Patient care areas re-purposed (PACU)
—Monitored units for ICU-level care
Facility damaged/unsafe, or, Non-patient care areas (e.g. classrooms, etc. ) used for patient care
StaffUsual staff called in and utilized Staff extension:
—Brief deferrals of non-emergent service
—Supervision of broader group of patients
—Change in responsibilities, documentation, etc.
Trained staff unavailable or unable to adequately care for volume of patients even with extension techniques
SuppliesCached and usual supplies used Conservation, adaptation, and substitution of supplies with occasional re-use of select supplies Critical supplies lacking, possible re-allocation of life-sustaining resources
Standard of care continuum:
Medical Standards of Care
 Conventional care1: usual care Contingency Care2 Crisis standards of care3: austere operating conditions
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Indicator: potential need to implement "crisis standards of care"
Trigger: "crisis standards of care"
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Incident demand / resource imbalance increases horizontal arrow

Risk of morbidity / mortality to patient increases horizontal arrow

1 "Conventional capacity: The spaces, staff, and supplies used are consistent with daily practices within the institution. These spaces and practices are used during a major mass casualty incident that triggers activation of the facility emergency operations plan."
2 "Contingency capacity: The spaces, staff, and supplies used are not consistent with daily practices but provide care that is functionally equivalent to usual patient care practices. These spaces or practices may be used temporarily during a major mass casualty incident or on a more sustained basis during a disaster (when the demands of the incident exceed community resources)."
3 "Crisis capacity: Adaptive spaces, staff, and supplies are not consistent with usual standards of care, but provide sufficient of care in the setting of a catastrophic disaster (i.e., provide the best possible care to patients given the circumstances and resources available). Crisis capacity activation constitutes a significant adjustment to standards of care."

* Adapted from:
Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, a Letter Report (Institute of Medicine of the National Academies, 2009, see especially pages 52-54).

See also: