{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:27:58Z","timestamp":1777681678038,"version":"3.51.4"},"reference-count":58,"publisher":"SAGE Publications","issue":"1_suppl","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Security"],"published-print":{"date-parts":[[2022,6,1]]},"abstract":"<jats:p>In fall 2020, COVID-19 infections accelerated across the United States. For many states, a surge in COVID-19 cases meant planning for the allocation of scarce resources. Crisis standards of care planning focuses on maintaining high-quality clinical care amid extreme operating conditions. One of the primary goals of crisis standards of care planning is to use all preventive measures available to avoid reaching crisis conditions and the complex triage decisionmaking involved therein. Strategies to stay out of crisis must respond to the actual experience of people on the frontlines, or the \u201cground truth,\u201d to ensure efforts to increase critical care bed numbers and augment staff, equipment, supplies, and medications to provide an effective response to a public health emergency. Successful management of a surge event where healthcare needs exceed capacity requires coordinated strategies for scarce resource allocation. In this article, we examine the ground truth challenges encountered in response efforts during the fall surge of 2020 for 2 states\u2014Nebraska and California\u2014and the strategies each state used to enable healthcare facilities to stay out of crisis standards of care. Through these 2 cases, we identify key tools deployed to reduce surge and barriers to coordinated statewide support of the healthcare infrastructure. Finally, we offer considerations for operationalizing key tools to alleviate surge and recommendations for stronger statewide coordination in future public health emergencies.<\/jats:p>","DOI":"10.1089\/hs.2021.0185","type":"journal-article","created":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T14:10:12Z","timestamp":1653315012000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Avoiding Crisis Conditions in the Healthcare Infrastructure: 2 Case Studies in Statewide Collaboration"],"prefix":"10.1177","volume":"20","author":[{"given":"Abigail E.","family":"Lowe","sequence":"first","affiliation":[{"name":"Abigail E. Lowe, MA, is an Assistant Professor, Global Center for Health Security, College of Allied Health Professions; at the University of Nebraska Medical Center, Omaha, NE."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hernando","family":"Garzon","sequence":"additional","affiliation":[{"name":"Hernando Garzon, MD, is Director, Emergency Response, California Department of Public Health, Sacramento, CA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel E.","family":"Lookadoo","sequence":"additional","affiliation":[{"name":"Rachel E. Lookadoo, JD, is Director of Legal and Public Health Preparedness, Center for Biosecurity, Biopreparedness, and Emerging Infectious Diseases, and an Instructor, Department of Epidemiology, College of Public Health; at the University of Nebraska Medical Center, Omaha, NE."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James V.","family":"Lawler","sequence":"additional","affiliation":[{"name":"James V. Lawler, MD, MPH, is Director of International Programs and Innovation, Global Center for Health Security, Director of Clinical and Biodefense Research, and Associate Professor, Department of Internal Medicine; at the University of Nebraska Medical Center, Omaha, NE."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dave","family":"Duncan","sequence":"additional","affiliation":[{"name":"Dave Duncan, MD, is Retired Director, California Emergency Medical Services Authority, Rancho Cordova, CA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelly","family":"Schwedhelm","sequence":"additional","affiliation":[{"name":"Shelly Schwedhelm, MSN, RN, NEA-BC, is Executive Director, Emergency Management and Biopreparedness, Nebraska Medicine, and Executive Director, Emergency Management and Clinical Operations, Global Center for Health Security; at the University of Nebraska Medical Center, Omaha, NE."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asha V.","family":"Devereaux","sequence":"additional","affiliation":[{"name":"Asha V. Devereaux, MD, MPH, FCCP, is a Senior Medical Officer, California Emergency Services Authority\/CAL-MAT, Rancho Cordova, CA, and a Clinician, Pulmonary Medicine, Sharp Coronado Hospital, Coronado, CA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"e_1_3_1_2_2","unstructured":"Hegarty A Van Sant J. State prepared with crisis plan for worst-case scenario in pandemic. KMTV. December 11 2020. Accessed September10 2021. https:\/\/www.3newsnow.com\/news\/investigations\/state-prepared-with-crisis-plan-for-worst-case-scenario-in-pandemic"},{"key":"e_1_3_1_3_2","volume-title":"Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework","author":"Institute of Medicine","unstructured":"Institute of Medicine. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework. 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