Revisiting Legal Foundations of Crisis Standards of Care

Experiences of Frontline Managers during the COVID-19 Pandemic: Recommendations for Organizational Resilience

The COVID-19 pandemic caused a global health crisis directly impacting the healthcare system. Healthcare leaders influence and shape the ability of an organization to cope with and recover from a crisis such as the COVID-19 pandemic. Their actions serve to guide and support nurses' actions through unpredictable health service demands. The purpose of this paper was to examine frontline managers' experiences and organizational leadership responses that activated organizational resilience during the COVID-19 pandemic, and to learn for ongoing and future responses to healthcare crises. Fourteen managers participated in semi-structured interviews. We found that: (1) leadership challenges (physical resources and emotional burden), (2) the influence of senior leader decision-making on managers (constant change, shortage of human resources, adapting care delivery, and cooperation and collaboration), and (3) lessons learned (managerial caring behaviours and role modelling, adaptive leadership, education and training, culture of care for self, and others) were evidence of managers' responses to the crisis. Overall, the study provides evidence of managers experiences during the early waves of the pandemic in supporting nurses and fostering organizational resilience. Knowing manager's experiences can facilitate planning, preparing, and strengthening their leadership strategies to improve work conditions is a high priority to manage and sustain nurses' mental health and wellbeing.

Standard of Care During a Crisis: What Should a Surgeon Know (and Do)?

Numerous catastrophic events in the 21st century have motivated renewed discussion regarding whether the traditional definition of standard of care appropriately applies to clinical decision-making in crisis scenarios. Some authorities have proposed the adoption of a crisis standard of care, which refines physician responsibilities during a crisis event in accordance with population health principles. However, this proposal is fraught with controversy, and current medical and legal scholarship on this topic remains complex and conflicted. To clarify these points and provide practicing neurosurgeons with guidance, we provide a review of current literature on the evolving definitions of crisis standard of care. Additionally, we provide an assessment of the implications of a crisis standard of care, as it relates to legal liability, clinical ethics, and neurosurgical practice.

Crisis Standards of Care

Nursing considerations during states of emergency.

The Energy of Finance in Refining of Medical Surge Capacity

The availability of resources and their concentration in the place of greatest need, will not allow us to successfully overcome a medical surge without the energy required to activate these resources and activities, and increase their quantities if necessary, that is why the staff and management of healthcare institutions are forced to making ethical crisis decisions about who wins and who loses. This study highlights the versatility of the concept of ‘energy’ by attributing it to money or financial resources, which are highly essential in dealing with surges as the healthcare system adopts the appropriate capacity level. This study considers the means (space, staff, supplies, and specific resources) at the disposal of healthcare institutions for the control of diseases as economic resources to identify ways for enhancing their capacity, especially during periods of medical surges such as that caused by the coronavirus disease (COVID-19). The medical resources are dependent on ‘energy’, albeit not in the strictest sense of the term. The article, thus, points out that while limited resources are the norm in economic theory, a medical surge provides an opportunity to sufficiently extend the resources within the health system capacity through increased funding.

Actionable, Revised (v.3), and Amplified American Burn Association Triage Tables for Mass Casualties: A Civilian Defense Guideline

Burn care remains among the most complex of the time-sensitive treatment interventions in medicine today. An enormous quantity of specialized resources are required to support the critical and complex modalities needed to meet the conventional standard of care for each patient with a critical burn injury. Because of these dependencies, a sudden surge of patients with critical burn injuries requiring immediate and prolonged care following a burn mass casualty incident (BMCI) will place immense stress on healthcare system assets, including supplies, space, and an experienced workforce (staff). Therefore, careful planning to maximize the efficient mobilization and rational use of burn care resources is essential to limit morbidity and mortality following a BMCI. The U.S. burn care profession is represented by the American Burn Association (ABA). This paper has been written by clinical experts and led by the ABA to provide further clarity regarding the capacity of the American healthcare system to absorb a surge of burn-injured patients. Furthermore, this paper intends to offer responders and clinicians evidence-based tools to guide their response and care efforts to maximize burn care capabilities based on realistic assumptions when confronted with a BMCI. This effort also aims to align recommendations in part with those of the Committee on Crisis Standards of Care for the Institute of Medicine, National Academies of Sciences. Their publication guided the work in this report, identified here as "conventional, contingency, and crisis standards of care." This paper also includes an update to the burn Triage Tables- Seriously Resource-Strained Situations (v.2).