arizona is now officially under
“crisis standards of care”
As of this evening, Arizona has officially entered the world of “Crisis Standards of Care”. It’s a term that has been around most of my career, but this is the first time I can remember it being implemented in Arizona.
“Crisis Standards of Care” is basically a protocol for making healthcare decisions when the system can’t provide all of the care that everybody needs because the needs outstrip the resources. In other words, it’s a protocol to help healthcare providers objectively decide who gets care when resources don’t allow everyone to get treatment.
This very important new document outlines how it’ll work over the coming weeks/months. The report specifies statewide triage protocols for hospitals to use when demand outstrips supply. It has a section on “Stabilization of Patients Awaiting Triage” and “Triage Protocols for Scarce Resource Allocation”. The triage protocols go into effect when a facility moves from normal care to Contingency or Crisis Levels of Care.
From a big picture point of view, all patients who can potentially benefit from therapies are offered treatment when resources are sufficient, but when resources aren’t, then all patients get assessed to determine how best to allocate care. The new triage protocol provides a way to make those decisions.
The standards thankfully state that nobody is supposed to be “… categorically denied care based on stereotypes, assumptions about any person’s quality of life, or judgement about a person’s “worth” based on the presence or absence of disabilities“. So that’s a good thing.
The Crisis Standards of Care protocol uses a 4-step process to determine how to prioritize patients. It’s a point-based system, and the people with lower scores would be a higher priority for treatment.
In Step 1, providers assign points to set priorities according to the patient’s “Sequential Organ Failure Assessment” (SOFA) score (a range between 1 to 4 points). In Step 1, a person with a low risk of multi-organ failure might get a score of 0 while a person with a high assessment for organ failure might get 4 points.
In Step 2, providers assign additional points based on “… the individual evaluation of the patient and consideration of 1 year or 5 year mortality” (an additional 4 points are possible). In this step, a person that would be expected to live at least another 5 years if they recover from COVID would get 0 points. Someone that would be expected to live a short time (a year or two) even if they recover would get 4 points.
In Step 3, you add the points from Step 1 and Step 2 and create a total triage score.
In Step 4, a person is given a color grouping based on the score. The people with lower scores have a “higher likelihood of benefiting from critical care” and scarce healthcare resources would be prioritized toward those with lower scores.
As I mentioned, patients with lower scores would be given priority for care. But sometimes, several people might have the same score (color coding). If that happens, the protocol says that additional factors may be considered as priorities. Those priorities include:
Pediatric patients < 18 years of age;
First responders or front-line healthcare workers;
Single caretakers for minors or dependent adults;
Pregnant patients; and
Opportunity to experience life stages (childhood, young adulthood, middle years, and older years).
As a patient’s condition changes over time, they can be reclassified into a different “color” reflecting a different priority for usage of scarce resources.
You can go to the COVID addendum document to dive into the details is here.
Now that Crisis Standards of Care have been declared, healthcare institutions and providers have additional liability protections recognizing the fact that they are unable to provide normal standards of care.
This is our new reality folks.