Biomedical Engineering Reference
In-Depth Information
Chapter G.4 The Larger Context:
Important Related Issues
The expert panel emphasized that, for health
systems and providers to respond effectively to a
mass casualty event, a number of important legal,
policy, and ethical issues related to altered stan-
dards of care must be addressed before such an
event occurs. These issues are discussed below.
from health and medical professionals closer to
the event.
While decisions made by those closer to the
event may trigger a move to altered standards
of care, policies that support the move to altered
standards must be put in place by the highest
levels of authority necessary. For example, during
a mass casualty event, a hospital may decide that
the demand for medical care has exceeded the
hospital's ability to provide care under normal
standards. This decision will require a move to
expanded functions for staff (e.g., nurses may
perform some physician duties). In this case the
decision to move to altered standards of care
emanates from the clinical level. However, it
is important that the appropriate higher level of
authority has put in place the policies, such as
provisions allowing the modification of State scope
of practice laws that support the decision and
empower the hospital's nurses or other health care
staff to provide an expanded level of care.
Examples of existing resources that offer starting
points for addressing questions of authority are
described in the accompanying exhibits. One is
a draft checklist developed by the American Bar
Association for State and local government attor-
neys to prepare for possible disasters (Figure G.5).
Another is the Model State Emergency Health
Powers Act (Figure G.6). A third is draft executive
orders developed in Colorado that create a legal
framework for an emergency and address a variety
of legal issues (Figure G.7).
The Authority to Activate the Use of
Altered Standards of Health and Medical
Care
It is important to establish clear authority to acti-
vate the use of altered standards of health and
medical care. The following questions pertain:
•
What circumstances will
trigger a call
for
altered standards of care?
•
Who is authorized to make that call, and at
what level (site, community, region, State, or
Federal) should the call be made?
•
Under what legal statutory authority, should the
call be made?
•
Once the call is made, who assumes responsi-
bility for directing emergency actions?
•
What is the relationship of otherwise
autonomous institutions to the incident manage-
ment system?
Generally, when a decision exceeds the authority
of a particular organization or region, responsibility
for the decision moves to the next level of deci-
sionmaking and authority. Nonetheless, it is advis-
able that State and local jurisdictions empower
local decisionmakers to act before Federal or other
outside assistance arrives. Some decisions may
emanate from public officials at higher levels of
authority, such as the mayor, governor, or presi-
dent, whereas clinical decisions will need to come
Legal and Regulatory Issues
The organization and delivery of health care
is highly regulated.
In a mass-casualty event,
it
is likely that some provisions for temporary
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