{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T01:28:33Z","timestamp":1782523713792,"version":"3.54.5"},"reference-count":33,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1049023X20001089_as1\"><jats:title>Introduction:<\/jats:title><jats:p>In 2009, the Institute of Medicine published guidelines for implementation of Crisis Standards of Care (CSC) at the state level in the United States (US). Based in part on the then concern for H1N1 pandemic, there was a recognized need for additional planning at the state level to maintain health system preparedness and conventional care standards when available resources become scarce. Despite the availability of this framework, in the years since and despite repeated large-scale domestic events, implementation remains mixed.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20001089_as2\"><jats:title>Problem:<\/jats:title><jats:p>Coronavirus disease 2019 (COVID-19) rejuvenates concern for how health systems can maintain quality care when faced with unrelenting burden. This study seeks to outline which states in the US have developed CSC and which areas of care have thus far been addressed.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20001089_as3\"><jats:title>Methods:<\/jats:title><jats:p>An online search was conducted for all 50 states in 2015 and again in 2020. For states without CSC plans online, state officials were contacted by email and phone. Public protocols were reviewed to assess for operational implementation capabilities, specifically highlighting guidance on ventilator use, burn management, sequential organ failure assessment (SOFA) score, pediatric standards, and reliance on influenza planning.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20001089_as4\"><jats:title>Results:<\/jats:title><jats:p>Thirty-six states in the US were actively developing (17) or had already developed (19) official CSC guidance. Fourteen states had no publicly acknowledged effort. Eleven of the 17 public plans had updated within five years, with a majority addressing ventilator usage (16\/17), influenza planning (14\/17), and pediatric care (15\/17), but substantially fewer addressing care for burn patients (9\/17).<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20001089_as5\"><jats:title>Conclusion:<\/jats:title><jats:p>Many states lacked publicly available guidance on maintaining standards of care during disasters, and many states with specific care guidelines had not sufficiently addressed the full spectrum of hazard to which their health care systems remain vulnerable.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1049023x20001089","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T08:28:33Z","timestamp":1599726513000},"page":"599-603","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":11,"title":["Crisis Standards of Care Implementation at the State Level in the United States"],"prefix":"10.1017","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2704-4428","authenticated-orcid":false,"given":"Colton","family":"Margus","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritu R.","family":"Sarin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1072-3811","authenticated-orcid":false,"given":"Michael","family":"Molloy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory R.","family":"Ciottone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,9,10]]},"reference":[{"key":"S1049023X20001089_ref24","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1086\/JCE201223405","article-title":"Bedside resource stewardship in disasters: a provider\u2019s dilemma practicing in an ethical gap","volume":"23","author":"Daniel","year":"2012","journal-title":"J Clin Ethics"},{"key":"S1049023X20001089_ref30","doi-asserted-by":"publisher","DOI":"10.1097\/DMP.0b013e31819ef060"},{"key":"S1049023X20001089_ref3","doi-asserted-by":"publisher","DOI":"10.1017\/dmp.2015.186"},{"key":"S1049023X20001089_ref4","first-page":"1","article-title":"Disaster-related shelter surveillance during the Hurricane Harvey response - Texas 2017","volume":"14","author":"Schnall","journal-title":"Disaster Med Public Health Prep"},{"key":"S1049023X20001089_ref15","unstructured":"15. 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Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}