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Altered standards of care (ASC)

We all expect certain standards of care when we visit our doctor or go to the hospital. Did you ever wonder what would happen to that care during an emergency situation? Normal standards of care may need to be altered during extreme conditions, such as disasters or pandemics. There are ethical principles that need to be addressed and competencies in emergency preparedness that need to be achieved.

Altered Standards Of Care

In some states licensing laws may be suspended or altered during a declared emergency but licensed health professionals should still be found by professional legal requirements. For example, a dentist does not become a surgeon nor does a nurse become pharmacist. There are no easy answers and guidance is the best any planner can do. It is the responsibility of every professional to be prepared to respond to an emergency and for everyone organization and institution to plan for practice emergency response.

Competencies:

A health care professional should be able to explain the meaning of the following:

  • National Incident Management System (NIMS)
  • Ethical principles in emergency care
  • Privacy
  • Individual liberty
  • Duty to provide
  • Equity care
  • Trust
  • Open and transparent
  • Responsive
  • Accountability
  • Inclusive

Altered standards of care may be needed due to severe natural events such as blizzards, hurricanes, heat waves, earthquakes or floods or transportation incidents such as plane crashes, a train derailment. Other situations may include industrial explosions, terrorist activities or infectious disease outbreaks.

These events can cause:

  • Loss of essential services such as water, electricity or supply chain
  • Loss of infrastructure that include electronic information and physical locations (buildings)
  • Size of affected population that requires triage
  • Increased capacity
  • Relocation of care to a facility not equipped for patient care

The most critical standards for clinicians providing care (after triage has been performed and patients have been transferred for care) are:

  • Maximizing worker and patient safety
  • Maintaining airway and breathing, circulation and control of blood loss
  • Maintaining or establishing infection control (including continuity of medications for conditions such as tuberculosis)

Less important actions that could be delayed or eliminated for some period of time or assigned to family members, non-licensed assistants or volunteers include:

  • Routine care activities (e.g., blood pressure checks in non-acute patients, assisted ambulation)
  • Administration of oral medications
  • Extensive documentation of care
  • Maintenance of complete privacy and confidentiality
  • Elective procedures

Recommendations

Pre-event:

  • Pre-event:Prepare self and family/significant others for potential emergencies, including the potential for the professional to be away for extended periods during an emergency.
  • Participate in continuing education on emergency preparedness, with particular attention to the application of NIMS and the National Response Plan within your current practice setting.
  • Participate in emergency drills and exercises at your practice site.
  • Make sure to have emergency water and food supplies stocked up
  • Know the legal basis for professional care, and the legal structure of your state regarding health professionals during emergencies. Make Sure to have a Survival Kit available including blankets, flashlights and a first aid kit. An example of this would be our Economy Emergency Backpack Kit
  • Provide clear information to any employer or any volunteer organization where you are enrolled about any limitations on availability or any special skills (e.g., experience with community or emergency triage) applicable to emergency conditions.
  • During an event:Make sure to have a standard first aid kit available to keep any minor injuries under control until professional care is there to help.
  • Use your professional competence to provide the best care possible given the resources and physical conditions under which you are working.
  • Use assigned or announced information resources to clarify any changes in protocols or staff roles.
  • Use available rapid training to update readiness to respond to the specific event.
  • Communicate difficulties responding as expected through the as¬signed chain of command as quickly as possible.

Economy Emergency Backpack

Post-event:

  • Participate in post-event evaluation.
  • Do a psychosocial needs assessment for self and family, and seek assistance if indicated.
  • Participate in activities to facilitate return to pre-event status.