CRISIS STANDARDS OF CARE - Novel Coronavirus (COVID-19)

CRISIS STANDARDS OF

CARE

CRISIS STANDARDS OF CARE

2020

PROMULGATION

The Idaho Crisis Standards of Care Plan will be used to provide a framework for the development and

implementation of crisis standards of care. The development of this plan was directed by a work group

comprised of legal, emergency management, emergency medical services, hospital, and public health

representatives from throughout the state.

The Idaho Crisis Standards of Care Plan will be implemented when a disaster event overwhelms usual health

and medical capabilities and capacities, resulting in an inability of the healthcare system to provide the

standard levels of care to patients. This plan provides the structure needed for collaborative development of

crisis standards of care clinical guidance by the State of Idaho Disaster Medical Advisory Committee,

comprised of subject matter experts, and the dissemination of guidance to the seven public health districts

and the healthcare system in Idaho.

In recognition of the emergency responsibilities of Idaho Department of Health and Welfare with the authority

vested in me as the Division Administrator, I hereby promulgate the Idaho Crisis Standards of Care Plan.

Digitally signed by

Elke Shaw-Tulloch

Date: 2020.06.29

10:28:24 -06'00'

____________________________________

Elke Shaw-Tulloch

Division Administrator

Division of Public Health

Idaho Department of Health and Welfare

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CRISIS STANDARDS OF CARE

2020

CONTRIBUTORS

IDAHO DEPARTMENT OF HEALTH AND WELFARE

Elke Shaw-Tulloch, MHS

Administrator

Division of Public Health

Christine Hahn, MD

State Medical Director

Division of Public Health

Marcia Witte, MD, FACP *

Public Health Physician

Division of Public Health

Nicole McKay, JD *

Deputy Attorney General

Sonja Schriever, RN *

Chief, Bureau of Community and Environmental Health

Division of Public Health

Denise Kern, MPH *

Public Health Emergency Preparedness Program Manager

Division of Public Health

Mezelle Moore, MPH

Hospital Preparedness Program Coordinator

Division of Public Health

EXTERNAL PARTNERS

Alicia Carrasco, MD, MA *

Boise VAMC

Zac Erekson, MD

St. Luke¡¯s Health System

Aaron H. Gardner, MD, MS, FAAP *

Brian Goltry, MD, FCCP

St. Luke¡¯s Health System

Christopher Keller, MD *

Nephrologist, Boise Kidney and Hypertension

Kenneth Krell, MD *

Division of Critical Care

Eastern Idaho Regional Medical Center

Rebecca Legg, MD *

Saint Alphonsus Regional Medical Center

Mel Leviton *

Executive Director

Idaho State Independent Living Council

Drew McRoberts, MD, FACS *

Trauma Director

Portneuf Medical Center

Travis Myklebust, NRP

Lewiston Fire Department/Idaho Fire Chief¡¯s Association

Dieuwke Dizney-Spencer, RN, MHS

Deputy Administrator

Division of Public Health

Magni Hamso, MD, MPH, FACP *

Medical Director

Division of Medicaid

Rob Adelson, JD*

Deputy Attorney General

Wayne Denny, MA

Chief, Bureau of EMS and Preparedness

Division of Public Health

Melissa Ball, RRT

Time Sensitive Emergency Program Manager

Division of Public Health

Jathan Nalls, NRP, FP-C

Program Manager, Bureau of EMS and Preparedness

Division of Public Health

Jodi Matott, BBA, BS

Plans Section Chief/ESF-8/Planner

Division of Public Health

Benjamin Cornett MD, FACEP *

Access Medical Director

Boise VAMC Emergency Physician

Billy Galligar, MD

Heart ¡®n Home Hospice

Mark S. Grajcar, DO *

Idaho State Board of Medicine

Initial Point Family Medicine/Founder

Peder Humlen-Ahearn MPSLA, NRP

Ada County Paramedics

Shasta Kilminster-Hadley, JD*

General Counsel, Idaho State Board of Medicine

Anne K. Lawler, JD, RN *

Executive Director

Idaho State Board of Medicine

Rebecca Legg, MD *

Saint Alphonsus Regional Medical Center

Michael Littman, BSN, LNHA

LaCrosse Health & Rehabilitation Center

Michael Meza, MD

Heritage Health

Post-Acute Care

Kenneth E. Newhouse, MD *

Chief Medical Officer

Bingham Healthcare

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CRISIS STANDARDS OF CARE

2020

Wendi Norris, MD, MSW *

St. Luke¡¯s Idaho Pulmonary Associates

Anil Patel, MD *

Saint Alphonsus Regional Medical Center

Deric Patterson, MD, MSPH, HMDC

St. Luke¡¯s Home Care and Hospice

Sherena A. Perry, DO, MA *

Director for Hospice/Palliative Care

CLC Attending/Internal Medicine Attending

Boise VAMC

Curtis Sandy, MD, FACEP, FAEMS

Chair, Idaho EMS Physician Commission

Daniel Preucil, MD *

Medical Director for Palliative Care

St. Luke¡¯s Magic Valley Regional Medical Center

Robert Scoggins, MD, PhD *

Medical Director of Critical Care and Respiratory Therapy

Kootenai Health

Christopher E. Way, BA, Paramedic

Chief, Kootenai County EMS System

CONSULTANTS

Andrew Lawless, MBA, PMP

Public Health Preparedness Planner

Coordinated Consulting Services

Katherine Stevens, MD *

St. Luke¡¯s Health System

Jeannette Zinggeler Berg, MD, PhD, MPH *

Pulmonary and Critical Care

Kootenai Health

P. Diane Reed, MA, REHS, RS, MEP, CPM

Public Health Preparedness Planner

Coordinated Consulting Services

*Members of the State of Idaho Medical Advisory Committee (SIDMAC) during April/May 2020

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CRISIS STANDARDS OF CARE

2020

TABLE OF CONTENTS

CONTRIBUTORS .......................................................................................................................................................................................... 2

RECORDS OF CHANGES .............................................................................................................................................................................. 6

INTRODUCTION (Purpose, Scope, Situation Overview) ............................................................................................................................. 7

PLANNING ASSUMPTIONS ......................................................................................................................................................................... 8

Healthcare Facility Indicators for Conventional, Contingency, and Crisis Care ..................................................................................... 9

General Healthcare Resource Maximization Strategies ........................................................................................................................ 9

SIDMAC Decision Areas ........................................................................................................................................................................ 10

ETHICAL CONSIDERATIONS ...................................................................................................................................................................... 10

STATEWIDE CONCEPT OF OPERATIONS ................................................................................................................................................... 11

Indicators for Crisis Standards of Care Activation ................................................................................................................................ 11

CSC Activation Process ......................................................................................................................................................................... 11

COORDINATING AGENCIES ROLES AND RESPONSIBILITIES ...................................................................................................................... 12

Primary Agency .................................................................................................................................................................................... 12

Coordination Agencies ......................................................................................................................................................................... 12

Public Health District (PHD) AuthoritIes .............................................................................................................................................. 13

County Emergency Management Agencies ......................................................................................................................................... 13

Support Agencies ................................................................................................................................................................................. 14

Regional Healthcare Coalitions ............................................................................................................................................................ 15

Federal Resources ................................................................................................................................................................................ 16

STATE OF IDAHO DISASTER MEDICAL ADVISORY COMMITTEE (SIDMAC) ROLES AND RESPONSIBILITIES............................................... 16

DIRECTION, CONTROL AND COORDINATION ........................................................................................................................................... 17

CLINICAL CONCEPT OF OPERATIONS ....................................................................................................................................................... 18

Emergency Medical Services (EMS) Triage .......................................................................................................................................... 19

Primary Triage ...................................................................................................................................................................................... 19

Secondary Triage .................................................................................................................................................................................. 20

Tertiary Triage ...................................................................................................................................................................................... 21

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