Crisis Standards of Care
Crisis standards of care (CSC) is when health care systems are so overwhelmed by a pervasive or catastrophic public health event it is impossible for them to provide the normal, or standard, level of care to patients. In situations like this, legal and regulatory protections and guidance by state government would occur to recognize health care systems are in crisis operations that may last for some time. MDH supports CSC planning as it is impossible to predict the timing and severity of a future outbreak and waiting for the disaster to strike would be too late.
Minnesota COVID Ethics Collaborative (MCEC)
The Minnesota Department of Health is actively participating in the Minnesota COVID Ethics Collaborative. This multidisciplinary group is focusing on the complex ethical decisions that may arise during this time.
- Ethical Framework for Transitions Between Conventional, Contingency, and Crisis Conditions in Pervasive or Catastrophic Public Health Events with Medical Surge Implications (PDF)
Created by the Minnesota Covid Ethics Collaborative during the pandemic response, this document is applicable to any response that involves movement along the crisis care continuum.
- Ethical Framework for Allocation of Monoclonal Antibodies during the COVID-19 Pandemic (PDF)
Overview of monoclonal therapies in use for the COVID-19 pandemic.
- Ethical Framework to Allocate Remdesivir in the COVID-19 Pandemic (PDF)
Past guidance, key ethical values, and the process for allocation of remdesivir among Minnesota health care facilities and patients.
- Allocation of Ventilators & Related Scarce Critical Care Resources During the COVID-19 Pandemic (PDF)
Statewide ethical guidance for the allocation of ventilators during COVID-19.
- Hospital Guidance: Making Cardiopulmonary Resuscitation Decisions in the Context of the COVID-19 Pandemic (PDF)
Statewide ethical guidance for acute care hospitals and performing CPR during COVID-19.
- Crisis Continuum Staffing Definitions (PDF)
Examples and definitions to help health care facilities understand where in along the crisis continuum they are for staffing. Common language and definitions are important during a response.
- National Academies of Sciences, Engineering, and Medicine: Rapid Expert Consultation on Staffing Considerations for Crisis Standards of Care for the COVID-19 Pandemic
NASEM outlines both community-wide strategies and health care system-specific strategies for staffing crises in health care settings during COVID-19.
Updated 8/2/21: The Delta variant can spread rapidly and there may be delays in identifying and reporting cases. Currently, MDH recommends eye protection for all health care workers (HCW) in all patient or resident care areas and when providing direct care.
In addition, MDH recommends all HCW wear a facemask regardless of vaccination status when in the health care setting. MDH recommends wearing a facemask during meetings and in the break room unless actively eating or drinking. Social distancing, limiting number of staff in a break room, or eating lunch outside are other recommended interventions to reduce risk of transmission.
- CDC Strategies for Optimizing the Supply of PPE
The CDC has release conventional, contingency and crisis strategies specific to eye protection, isolation gowns, facemasks, and N95 respirators.
- CDC: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
- CDC: Optimizing Personal Protective Equipment (PPE) Supplies
- OSHA: COVID-19 Healthcare ETS
- Patient Care Strategies for Scarce Resource Situations (PDF)
A standardized tool to assist Minnesota hospitals, clinics or primary care settings in determining the best use of specialized equipment and supplies during a pervasive or catastrophic public health event.
- Adult Veno-Venous (VV) Extracorporeal Membrane Oxygenation (ECMO) Eligibility Criteria for COVID-19 ARDS (PDF)
From the Minnesota ECMO Consortium.
- Pharmaceutical Shortages for Minnesota Hospitals (PDF)
Frequently Asked Questions.
These resources are developed and maintained by the MDH Science Advisory Team (SAT). The SAT is devised of subject matter experts from different backgrounds including—critical care physicians, primary care, psychiatrists, pharmacists, ethicists, hospital administration, legal and other disciplines—to develop guidance for hospitals, health systems, and health care coalitions. The SAT advises the MDH Commissioner on strategies for optimal allocation of scarce resources during crisis standards of care situations including ethical and policy considerations.
The goal of the Minnesota CSC Framework is twofold:
- To outline the Minnesota Department of Health response during a Crisis Standards of Care situation and
- To provide planning guidance to health care and public health organizations to successfully manage the transition from conventional to contingency to crisis care and a shift in care from individual patients to the good of the community.
It is broken down into six categories:
- MDH Crisis Standards of Care CONOPS (PDF)
This document describes the roles and responsibilities of MDH during a crisis standards of care response.
- Minnesota CSC Ethical Considerations
- Minnesota CSC Legal Considerations
- Minnesota CSC EMS Considerations
- Minnesota CSC Health Care Facility Considerations
- Minnesota CSC Community Engagement Considerations
- An Overview of Catastrophic Planning in Minnesota (PDF)
This report provides a historical overview of catastrophic planning in Minnesota. It reviews how the Science Advisory Team has played an integral role in material development for Minnesota, the Minnesota Pandemics Project, the development of the Minnesota Framework, and the future of this project.