We offer insights from facilitating numerous community meetings in three U.S. states about allocating scarce medical resources during a health emergency. These insights may be useful to public health officials and others currently grappling with preparations for and response to the COVID-19 coronavirus.
Community Preparedness and Resilience for Public Health EmergenciesInsights for Response to the CoronavirusCatastrophic events like the current COVID-19 coronavirus epidemic demonstrate how major public health crises can overwhelm even the most sophisticated healthcare systems. Other disasters – natural or manmade – can also overwhelm or stress healthcare systems. When hundreds or thousands of people suddenly require medical attention, medical professionals can find themselves overwhelmed and unable to provide the level of care typically administered. In these circumstances, medical professionals may be forced to make difficult ethical decisions regarding who gets access to limited medical supplies and life-sustaining resources, such as hospital beds, ventilators, or – as has been the case in the United States in recent weeks – test kits to assess whether a patient has a potentially deadly virus.To help communities prepare for these circumstances, the Institute of Medicine (IOM) issued a report in 2009 on how state governments can establish and implement guidelines for providing care during extreme crises. These guidelines – called Crisis Standards of Care (CSC) – help medical professionals decide how to change their practice when there are not enough resources for all patients or it is otherwise impossible to provide the usual level of care. While this guidance was developed at the request of the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services, the information provided in the report may be useful to public health officials around the globe.As the IOM report indicates, CSC guidelines should be developed before a crisis hits. Several U.S. states have already taken steps to develop this guidance. In recent years RESOLVE has worked closely with the states of Maryland, Illinois, and Washington to design and facilitate community engagement initiatives to help ensure that the development and implementation of each state’s guidelines are informed by and aligned with residents’ values and priorities. RESOLVE Senior Mediators Beth Weaver and Maya Breitburg-Smith are scheduled to present key lessons learned from this work during the 2020 Preparedness Summit in Dallas, Texas later this month.While pre-disaster planning is most effective, there are some important takeaways from our CSC work that may be useful to elected officials, public health officials, community leaders, and organizations currently grappling with preparations for and response to the COVID-19 coronavirus.- Be clear and transparent about how decisions will be made about allocating limited life-sustaining resources during a public health crisis. Make the public aware of how decisions will be made about allocating limited life-sustaining medical resources before such decisions need to be made. Sharing this information as early as possible is important because people are generally less able to process and rationalize complex information during high-stress events. And, knowing in advance how these decisions will be made may lead to greater acceptance of these decisions and trust in the decision makers. - When possible, gather community input to inform decisions about allocating limited life-sustaining resources. Gathering a diverse array of community input can help policymakers create more equitable policies and implementation guidance that will better suit the varying needs and values of those within the community. This may not always be possible in the middle of an emergency, but developing plans that reflect the diverse values and perspectives of a community can go a long way in helping a community weather a crisis. Connect with as many of the diverse populations within a community as possible to understand the various perspectives and values that may exist within the community. Make it clear why you are seeking feedback and how it will be used. Focus on gathering honest, diverse input rather than seeking agreement. Create a safe space for conversation, where no opinion is criticized or discounted. Consider working with a professional facilitator and/or trusted community leader to help design and facilitate the conversation.- Transparent communication and information sharing during a crisis is imperative. Providing comprehensive, accurate, and timely information from credible officials is critical. Rumors or false information can easily circulate within a community or online, and this can have real consequences during a public health emergency. Public health officials and professionals are often trusted sources of information. Frequent and consistent information from these sources can help reassure individuals that they have the information they need to make decisions about how best to keep themselves and their families as safe and healthy as possible.- Use a variety of communications methods to share critical information. People access and absorb information in different ways, so it is important to get key information out to the public in as many ways as possible (e.g., traditional media outlets, social media, public service announcements, community newsletters, community list-servs and other networks). Efforts should be made to reach all residents, including those who cannot or chose not to use web-based technology, those currently experiencing homelessness, and migrant populations. When possible, survey a diverse group of community members to understand the various ways in which they tend to seek and receive important information. Work with trusted community leaders (e.g., religious leaders, social service organizations) to help distribute information to their networks.- Make sure information is easily understandable and available in multiple languages. It is important to provide information in a way that it is easily understandable to the general population. Messages should be clear, focused, and easily comprehensible to a variety of reading levels. Information should also be easily accessible to non-English speakers, so it is important to translate information into the major languages that are spoken within a community. Make it clear where people can direct their questions or learn more about the situation. And, make it clear where they can go for help.- Take special care to consider how best to protect and serve especially vulnerable populations. During public health emergencies, certain populations may be especially impacted by the crisis. For example, with the COVID-19 coronavirus, health officials have noted that individuals over the age of 60 and those who already suffer from other medical situations may be especially hard hit by the virus. Which populations are most vulnerable will depend on the nature of the crisis, but elected officials and health officials should make a special effort to identify especially vulnerable populations and to develop plans for sustained communication with and assistance to these populations.The COVID-19 coronavirus epidemic is certainly cause for global concern, but we should take comfort in the fact that communities typically have pre-established emergency preparedness plans in place to draw from during times of crisis. Communities should make periodic efforts to revisit and revise these plans as needed to ensure they meet the needs of those they are meant to serve.Beth WeaverSenior MediatorRESOLVE
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