Homeland Security Watch

News and analysis of critical issues in homeland security

April 2, 2012

Biosecurity and Crisis Standards of Care

Filed under: Biosecurity,Catastrophes,Preparedness and Response — by Arnold Bogis on April 2, 2012

I wish I could weave a proper narrative connecting the two issues I mention in the title of this post.  But beyond the obvious facts that a natural pandemic or bioterrorist attack could strain medical and public health resources at every level to the breaking point, thus requiring what is referred to as “crisis standards of care” –the basic concept of expending available if limited resources in helping the most people instead of just a few at everyday levels of effort where everything possible is tried to save lives. Alternatively, there are scenarios that could require crisis standards of care that aren’t related to biology, say a nuclear attack, or biological attacks or naturally occurring outbreaks of disease that can be adequately responded to without extraordinary measures.

All that a wordy explanation that the following is just for your information in case you missed it.

The first is a collection of biosecurity-related articles from the journal Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. The publishers, the Center for Biosecurity at the University of Pittsburgh Medical Center, describe this effort as looking back at progress made over the past decade:

To document and synthesize the achievements of the past decade and help chart the direction of future efforts, the Center for Biosecurity, with support from the Sloan Foundation, has assembled this series of 7 review articles as a special feature A Decade in Biosecurity. These articles, commissioned by the Center and peer reviewed, describe the current state of affairs in biosecurity policy and practice, identify remaining challenges and priorities, and articulate priorities for the field in the years ahead. The articles are authored by leaders in the field, with topics chosen to address the most critical policy issues and to offer recommendations for the future.

Hopefully they won’t mind me reproducing their content page below:

A Decade in Biosecurity: Contents

Introduction
By Tom Inglesby and D. A. Henderson, Coeditors-in-Chief
Journal contents


Public Health Surveillance and Infectious Disease Detection

By Stephen S. Morse
Despite improvements in the past decade, public health surveillance capabilities remain limited and fragmented, with uneven global coverage. Recent initiatives provide hope of addressing this issue, and new technological and conceptual advances could, for the first time, place capability for global surveillance within reach.
Read article
| Journal contents


Preventing Biological Weapon Development Through the Governance of Life Science Research

By Gerald L. Epstein
Since before the September 11 attacks, the science and security communities in the U.S. have struggled to develop governance processes that can simultaneously minimize the risk of misuse of the life sciences, promote their beneficial applications, and protect the public trust.
Read article
| Journal contents


The Evolution of Law in Biopreparedness

By James G. Hodge, Jr.
Over the past 10 years, a transformative series of legal changes have effectively (1) rebuilt components of federal, state, and local governments to improve response efforts; (2) created a new legal classification known as “public health emergencies”; and (3) overhauled existing legal norms defining the roles and responsibilities of public and private actors in emergency response efforts. Read article | Journal contents


A Decade of Countering Bioterrorism: Incremental Progress, Fundamental Failings

By Richard Danzig
This article suggests that our responses over the past decade can be sorted into 4 levels in order of increasing difficulty: we rapidly appropriated funds, augmented personnel, and mandated reorganization of agencies; we amplified ongoing efforts; we have so far had only glimmers of possibility in evolving new strategies to deal with this largely unprecedented problem; and, still to be realized, we need to overcome resistances inherent in our country’s cultural and political framework. Read article | Journal contents

 

Assessing a Decade of Public Health Preparedness: Progress on the Precipice?
By Elin Gursky and Gregory Bice
Balancing traditional public health roles with new preparedness responsibilities heightened public health’s visibility, but it also presented significant complexities. Currently, a rapidly diminishing public health infrastructure at the state and local levels as a result of federal budget cuts and a poor economy serve as significant barriers to sustaining these nascent federal public health preparedness efforts. Read article | Journal contents


U.S. Medical Countermeasure Development Since 2001: A Long Way Yet to Go

By Philip Russell and Gigi Kwik Gronvall
The U.S. government has taken significant steps toward developing and acquiring vaccines, drugs, and other medical countermeasures (MCMs) to protect and treat the population after a biological attack, but the efforts lack central leadership and accountability and the pace of progress has been slow. This article reviews areas of progress and summarizes the areas where improvements are needed. Read article | Journal contents

 

The People’s Role in U.S. National Health Security: Past, Present, and Future
By Monica Schoch-Spana
Over the past decade, assumptions have been made and unmade about what officials can expect of average people confronting a bioterrorist attack or other major health incident. The reframing of the public in national discourse from a panic-stricken mob to a band of hearty survivors is a positive development and more realistic in terms of the empirical record. Read article | Journal contents

The crisis standards of care piece comes from the Institute of Medicine.  It builds off of an earlier report that defined the topic and provides templates for those organizations that will need to do the difficult work of planning for such an ethically fraught state and implementing altered standards of care with all of the potential repercussions:

Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response 

In 2011 alone, a tornado devastated Joplin, Missouri, and earthquakes rocked New Zealand and Japan, underscoring how quickly and completely health systems can be overwhelmed. Disasters can stress health care systems to the breaking point and disrupt delivery of vital medical services.

At the request of the HHS, the IOM formed a committee in 2009, which developed guidance that health officials could use to establish and implement standards of care during disasters. In its first report, the committee defined “crisis standards of care” (CSC) as a state of being that indicates a substantial change in health care operations and the level of care that can be delivered in a public health emergency, justified by specific circumstances. During disasters, medical care must promote the use of limited resources to benefit the population as a whole.

In this report, the IOM examines the effect of its 2009 report, and develops vital templates to guide the efforts of professionals and organizations responsible for CSC planning and implementations. Integrated planning for a coordinated response by state and local governments, EMS, health care organizations, and health care providers in the community is critical to successfully responding to disasters. The report provides a foundation of underlying principles, steps needed to achieve implementation, and the pillars of the emergency response system, each separate and yet together upholding the jurisdictions that have the overarching authority for ensuring that CSC planning and response occurs.

The report can be downloaded here: http://www.nap.edu/catalog.php?record_id=13351

It can be read online here: http://books.nap.edu/openbook.php?record_id=13351

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2 Comments »

Comment by William R. Cumming

April 3, 2012 @ 12:50 am

Amazingly helpful post Arnold and thanks for those whose efforts are reflected.

Comment by Tom Russo

April 10, 2012 @ 11:12 am

I agree with your statement “I wish I could weave a proper narrative connecting the two issues I mention in the title of this post” which was a response to the IOM Report title “Biosecurity and Crisis Standards of Care.

I looked at the frameworks of Hicks presented in the IOM report in some of his early work and applied it to medical surge…internal and external. I also “looked” at the IOM report you reference…its 577 pages so thus far it has only been a look!

The topic of crisis standards of care, presented by Hicks has more to do with preparing the medical community for emergency response than it had to do with biosecurity. The piece I did appeared in a special June issue of the Journal of the South Carolina Medical Association that featured, ironically the same title Crisis Standards of Care.

I also confess that in a recent paper, published in HSAJ that went by the title Pandemic Vaccine Distribution Policy for the Twenty-First Century, the original title was “Biosecurity and Pandemic Policy for the Twenty-First Century.” The Publication’s managing editor and executive editor urged me to reconsider inclusion of the term “biosecurity” since the focus was about policy for pandemic vaccine distribution. The use of biosecurity would be a stretch. I knew that but wanted to agitate interest in the piece. They knew that too and so it was published shed of its biosecurity cloak. My point is I have read several articles where the title alludes to biosecurity but the contents are more about response and less about security.

https://www.scmedical.org/uploads/files/June%20Journal%202011.pdf

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