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U.S. Department of Health and Human Services
Crisis Sta​ndards of Care
What are Crisis Standards of Care?

In its 2009 Letter Report, the Institute of Medicine's (IOM) Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations defined crisis standards of care (CSC) to be a “substantial change in the usual health care operations and the level of care it is possible to deliver….justified by specific circumstances and…formally declared by a state government in recognition that crisis operations will in effect for a sustained period” (Institute of Medicine. (2009). Guidance for establishing crisis standards of care for use in disaster situations: A letter report. Washington, DC:, The National Academies Press, p3). CSC planned and implemented in accordance with ethical values are necessary for the allocation of scarce resources. Public health disasters justify temporarily adjusting practice standards and/or shifting the balance of ethical concerns to emphasize the needs of the community rather than the needs of individuals. The goal for the healthcare system is to increase the ability to stay in conventional and contingency categories through preparedness and anticipation of resource needs prior to serious shortages, and to return as quickly as possible from crisis back across the continuum to conventional care.
Put simply, the development of CSC plans is the means to mount a response to an incident that far exceeds a community’s usual health and medical capacities and capabilities. 
Medical care delivered during disasters shifts beyond focusing on individuals to promoting the thoughtful stewardship of limited resources intended to result in the best possible health outcomes for the population as a whole.
The IOM’s Preparedness Forum was established to foster dialogue among a broad range of stakeholders—practitioners, policy makers, community members, academics, and others — and to provide ongoing opportunities to confront issues of mutual interest and concern.
The goals of the workshops on CSC were to learn from the work already being done to develop state, regional, and local crisis standards of care policies and protocols; to identify areas that require further development, research, and consideration; and to facilitate communication and collaboration among neighboring jurisdictions.
At the request of HHS/ASPR, the IOM convened the Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations to develop guidance that state and local public health officials can use to establish and implement standards of care that should apply in disaster situations—both naturally occurring and manmade—under scarce resource conditions.

Read the IOM's Crisis Standards of Care publication
Select the volume of the Crisis Standards of Care that addresses your functional area.