Category Archives: Disaster Preparedness

Crisis Standards of Care: Are You Familiar?

by: Denise M. Danna, RN, DNS, NEA, BC, CNE. FACHE

Due to such disasters as Hurricane Katrina, the tornado in Joplin, and various other
catastrophic events across the country and globe, the Department of Health and Human Services (HHS) requested that the Institute of Medicine (IOM) create a committee to develop standards of care during disasters. As citizens, we frequently experience how our health care system and the infrastructure of a community can be overwhelmed in such catastrophic disasters.

Several reports were generated from the IOM committee on Crisis Standards of Care (CSC). The first report in 2009, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations developed a definition of crisis standards of care “as a substantial change in usual health care operations and the level of care it is possible to deliver, which is made necessary by a pervasive (e.g. pandemic influenza) or catastrophic (e.g. earthquake, hurricane) disaster. This change in the level of care delivered is justified by specific circumstances and is formally declared by a state government, in recognition that crisis operations will be in effect for a sustained period. The formal declaration that crisis standards of care are in operation enables specific legal/regulatory powers and protections for healthcare providers in the necessary tasks of allocating and using scarce medical resources and implementing alternate care facility operations” (IOM, 2009). The second report entitled, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response (IOM, 2012) developed CSC templates to assist and guide individuals and organizations in CSC planning and implementation (IOM, 2012). Some of the main reasons that CSC protocols are needed in catastrophic disasters are to ensure that critical resources are provided to those individuals who will benefit the most, conserve limited resources, and ensure that all individuals receive the same access to the best possible care.

Nurses play a vital part in participating in the development of CSC. I was asked to participate in an interdisciplinary task force charged with developing crisis standards of care protocol. My section was writing “Delivery of Care Guidelines for Essential Inpatient Nursing Care” (Louisiana Department of Health & Hospitals, 2011). In developing the essential inpatient nursing care guidelines, the ANA report, Adapting Standards of Care Under Extreme Conditions: Guidance for Professionals During Disasters, Pandemics, and Other Extreme Emergencies (2008) was referenced. This report identified critical standards for healthcare providers that should always be maintained during a disaster (e.g. worker and patient safety, maintaining airway and breathing, circulation, control blood loss, and infection control (ANA, p. 16). Standards of care that could be adapted under extreme conditions included such activities as routine care (e.g. vital signs for non-acute patients), extensive documentation of care, and elective procedures (ANA, p. 16).

It is recommended that each hospital develop its own recommendations for providing essential nursing care during a catastrophic disaster that mirrors the community’s in which they live (Murray, 2012). Nurses serve an important role in disasters. Nurses should familiarize themselves with CSC and work within their organizations and communities to develop and implement CSC. During times of disasters, scarce resources may occur and nurses need to know how standards of care may be adapted while still providing safe, ethical and quality nursing care (Murray, 2012).


ANA (2008). Adapting Standards of Care Under Extreme Conditions: Guidance for
Professionals During Disasters, Pandemics, and Other Extreme Emergencies. Retrieved

Institute of Medicine (2009). Report Brief. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. Retrieved from:

Click to access Guidance%20for%20Est%20CSC%20for%20Use%20in%20Disaster%20Situations%20A%20Letter%20Rpt.pdf

Institute of Medicine (2012). Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Retrieved from:

Louisiana Department of Health & Hospitals. ESF-8 Health & Medical Section. State Hospital Crisis Standard of Care Guidelines in Disasters (Version 1.2 September 2011).Retrieved from:

Click to access LA%20State%20Hospital%20CSC%20Guidelines%20in%20Disasters.pdf

Murray, J. (2012). Crisis Standards of Care: A framework for responding to catastrophic disasters. AJN, 112 (10), 61-63.

Now is the Time, Personal Preparedness Can’t Wait!

On August 25, 2017, Hurricane Harvey made landfall in Texas leading to catastrophic flooding in Houston and surrounding areas.  Less than two weeks later, Hurricane Irma slammed into the Caribbean and Florida, causing flooding, damage, and widespread power outages.  Most hospitals in the impacted areas sheltered-in-place requiring nurses and other critical staff to stay at the facilities for extended periods.

While these disasters had some advance warning, many aspects of the disaster were uncertain including the extent and location of flooding, power outages, etc. Other disasters, such as tornadoes or earthquakes, strike with little or no warning. Previous studies have found that lack of personal preparedness, concern/fear for family and pets, concern for the effect of the disaster on self and personal property, and transportation difficulties pose major barriers to disaster response. Although many agree that healthcare organizations should address the personal preparedness of their employees, little is known about the degree to which the U.S. nursing workforce is personally prepared to respond to disasters for extended periods of time.

The Society for the Advancement of Disaster Nursing believes personal preparedness of the nursing workforce is paramount. This week, SADN members will be hosting a presentation on personal preparedness at the Emergency Nurses 2017 Conference in St. Louis, MO (Details below).

Title: Now is the Time, Personal Preparedness Can’t Wait!
Date: Thursday, September 14, 2017
Presentation time 3:15 PM – 4:15 PM
Room: 267

We hope conference attendees will be able to join us for this session.

For nurses who are not attending this conference, we recommend you undertake the following steps to get prepared as soon as possible:

  1. Assemble disaster supplies kit for home, work, and car
  2. Create a family disaster plan. Your family may not be together if a disaster strikes, so it is important to know which types of disasters could affect your area and have a plan in place that addresses how you’ll contact one another and reconnect if separated. Tailor this plan to any special needs your family has, including care of pets.
  3. Practice and update your plan regularly, just like a fire drill.
  4. Familiarize yourself with your organization’s emergency operations plan and know your role if a disaster strikes.

See for more information on becoming personally prepared.

Alicia Gable, MPH

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