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About the Communities of Interest 
Welcome to the HHS/ASPR Communities of Interest site

Devastating catastrophes—including a tornado that devastated Joplin, Missouri; earthquakes that rocked Christchurch, New Zealand; an earthquake that struck Japan and triggered a powerful tsunami; and Hurricane Sandy—underscored how quickly and completely health systems can be overwhelmed. Disasters, whether they occur suddenly and are unexpected or are caused by slow, sustained public health emergencies, can stress health care systems to the breaking point and disrupt delivery of vital medical services.

In response to a Government Accountability Office recommendation, HHS/ASPR developed a Communities of Interest (COI) SharePoint site (i.e., a clearinghouse) to better share information and manage documents; share promising practices and ideas; and provide a workspace where users from inside and outside HHS/ASPR can come together to share documents and ideas regarding the Crisis Standards of Care (CSC) and Allocation of Scarce Resources (ASR). We use the term “communities of interest” to describe all of the interested parties involved in CSC and ASR planning. 

The HHS/ASPR COI site is a growing and evolving resource

It is our hope that the COI site will serve as a continuing:
  • Touchstone on the existing CSC and ASR planning documents;
  •   Springboard for what one needs to know about these issues, as the science, research, and best practices continue to evolve; and
  • One-stop shopping CSC and ASR resource library and document repository.



What are Crisis Standards of Care?

In its 2009 Letter Report, the Institute of Medicine (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” (IOM, 2009, 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. 
What is the Allocation of Scarce Resources?

The “allocation of scarce resources” is the determination of how to equitably and fairly use scarce medical resources available in a contingency or crisis care environment. “Scarce resources” is defined as medical care resources that are likely to be scarce in a crisis care environment. Potential medical care resources that may become scarce during a disaster or emergency include physical items (e.g., medical supplies, drugs, beds, equipment), services (e.g., medical treatments, nursing care, palliative care), and health care personnel (e.g., physicians, nurses, psychologists, laboratory technicians, EMS providers, and other essential workers).

Depending on the scale of a disaster or emergency, a range of responses will be required from providers, health care institutions, regional coalitions, and public health agencies. The range of these responses will depend on the severity of the disaster or emergency. According to the Institute of Medicine (IOM), the response “…can be envisioned as occurring along a continuum based on resource availability and demand for health care services. One end of this continuum is defined by conventional responses—those services that are provided in health care facilities on a daily basis and are expanded for disaster planning and response. At the other end of the continuum is crisis care, when the best possible care is provided to the population of patients as a whole because of the very limited resources available. Significant changes are made in the methods and locations of care delivery, and decision-making shifts from patient-centered to population-centered outcomes” (Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Vol. 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. p.36-37). In a crisis situation, clinical practice may need to be adjusted in the face of severe medical resource deficits but done in a manner consistent with ethically valid goals and desired outcomes using a population-based approach. The emphasis in a public health emergency must be on improving and maximizing the population’s health while tending to the needs of patients within the constraints of resource limitations (Institute of Medicine. 2012. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Vol. 1: Introduction and CSC Framework. Washington, DC: The National Academies Press. p.36-37). Planning and proactive implementation of strategies to carefully steward resources may help health care providers avoid reaching the point at which crisis care must be provided and scarce resources allocated.
What does the HHS/ASPR COI site provide?

Sample Plans
Contained within the site are sample CSC and ASR plans that have been developed by HHS/ASPR National Healthcare Preparedness Program (NHPP) awardees or submissions from other sources. These sample plans allow those that are just getting started with developing CSC or ASC plans to see how their peers are planning and what they are thinking about these important issues.

View Sample Plans

Please Share Your Work
When you have completed developing a plan for your city, municipality, tribal area, state, community or region, please share your plan with us so others can benefit from your experience and knowledge.

Share Your Work

Guidance and Reports
In the report, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response (2012), the IOM examined the effect of its 2009 Letter Report, and developed a set of vital templates to guide the efforts of professionals and organizations responsible for CSC planning and implementation. This guidance was co-sponsored by HHS/ASPR, the Veterans Health Administration, and the Department of Transportation, National Highway Traffic Safety Administration (NHTSA).

In June 2012, the RAND Corporation completed a HHS/ASPR-sponsored comparative effectiveness review, Allocation of Scarce Resources during Mass Casualty Events. This review sought to identify the best available evidence regarding strategies for allocating scarce resources during mass casualty events (MCEs).

In January 2012, HHS/ASPR published its Healthcare Preparedness Capabilities Guidance for its NHPP cooperative agreements to promote communities building and strengthen their healthcare coalitions thereby creating a more comprehensive and resilient system of response. This document provides state guidance and protocols on CSC in order to enable a substantial change in routine healthcare operations including delivery of the optimal level of patient care for a pervasive (e.g., pandemic influenza) or catastrophic (e.g., earthquake, hurricane) disaster.