Public health experts propose standards for response to epidemics, disasters

October 2015 | Around the ABA

As the frequency and intensity of global disaster events continue to make front page news and authorities in the affected areas grapple to create safer environments, authorities elsewhere are focused on disaster planning strategies at home.  In the United States, attention has been focused on preparing for the provision of medical care under disaster conditions and planning for ever-worsening crises, including catastrophic terrorism, cataclysmic natural disaster and virulent pandemic.

“If a disease outbreak scenario calls for a disease control measure, the legal issues are not just limited to the nature of state and local legal authorities,” said Tara Ramanathan, public health analyst with the U.S. Centers for Disease Control and Prevention’s Public Health Law Program. “The power of government to control diseases–isolation and quarantine individuals–must be balanced with individual rights.”

At the 2015 ABA  Annual Meeting in Chicago, representatives from the Network for Public Health Law, the U.S. Centers for Disease Control and Prevention and Texas’ Harris County Public Health and Environmental Services came together to explore dealing with liability concerns through sustained public health emergencies, disruption of vital medical services and scarcity of resources. The program, “Public Health and Safety During an Epidemic: Convergence of Law, Policy, and Community,” was sponsored by the Health Law Section.

Panelists stressed the importance of having a responsive legal and regulatory environment during times of catastrophic disasters, and discussed the need for a coordinated and integrated approach–across the full spectrum of emergency response stakeholders–to guarantee that all providers act under a framework to establish and implement standards of medical care and ensure an effective response to public health concerns.

“When disease control measures are implemented, they move beyond general statements of law or policy and they affect the health care environment, the facility environment and the community as a whole,” Ramanathan said.

According to the experts, planning for an integrated, coordinated response by state and local governments, emergency medical services, health care organizations and health care providers in the community is critical to successfully responding to disasters.

Donna E. Levin, national director of the Network for Public Health Law in Saint Paul, Minn., spoke about the Crisis Standards of Care proposed by the National Academies Institute of Medicine, which offers a framework to deal with the substantial change in health care operations and with the level of care that can be delivered in a public health emergency, justified by the circumstances.

“Normally the health care provider is treating the patient in front of them using all of the resources that they have to bear for that patient,” Levin said. “In Crisis Standards of Care physicians, nurses, health care providers are actually looking beyond that patient and taking into account the community as a whole and how resources should be used to save as many lives as possible for the greater good.” 

Crisis Standards of Care is one critical component of disaster planning and is necessary to equitably allocate scarce resources. Levin said that medical care delivered during disasters shifts beyond focusing on individuals to promoting the thoughtful stewardship of limited resources intended to result in the best possible health outcomes for the population as a whole.

The Institute of Medicine’s report, “Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response,” provides a resource manual to guide health care organizations, public health agencies, first responder teams and government agencies in delivering care as effectively as possible to the greatest number of people when such disasters occur.

Having a responsive legal and regulatory environment is also important. Umair A. Shah, executive director for the Harris County Public Health and Environmental Services in Houston, discussed public engagement and the importance of weaving legal and ethical values into the broader context of disaster planning and the core of emergency response system.

Shah said that for Crisis Standards of Care planning to be implemented successfully, it must be embraced by the full spectrum of disciplines that participate in an emergency response.

“It is our job as a community, as a population and as a public health system to enact the protocols in place in advance, in a methodical, deliberate, planned way prior to the emergency just like you would do for a pilot, for a chef and for an ACLS [advanced cardiac life support] protocol in an emergency department,” Shah said.