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.

On this page:
News
COVID-19 Response
Staffing
Patient Care Strategies for Scarce Resource Situations
Minnesota Framework
Historic Overview

News

• Recommendations for Ethical Allocation of Sterilized Fluids (PDF)
  Recommendations to ethically address a critical sterilized fluid shortage that will likely last through 2024. 
   
• Every Crisis Is an Opportunity: Advancing Blood Culture Stewardship During a Blood Culture Bottle Shortage
  Framework on how to manage supply of blood culture bottles during shortage with specific examples of mitigation measures for conventional, contingency, and crisis capacity. Companion piece to Managing Blood Culture Bottle Shortages from the American Society of Microbiology.
  Posted 9/9/2024
   
• FDA: Disruptions in Availability of BD BACTEC Blood Culture Media Bottles - Letter to Health Care Providers
  Posted 7/10/2024
   
• Recommendations for Ethical Allocation of RhIG (PDF)
  A guide to care delivery and a basis for consistent response across Minnesota during the national shortage of RhIG.
  Posted 5/1/2024

COVID-19 Response

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.
  Updated 11/24/2021
   
  • Clinical Companion: Critical Care Guidance for Contingency and Crisis Conditions (PDF)
    This document is a companion document to the above Ethical Framework for Transitions Between Conventional, Contingency and Crisis Conditions in Pervasive or Catastrophic Public Health Events with Medical Surge Implications. It assists health care facilities with developing and implementing strategies to extend resources to avoid crisis conditions and establishing transparent and fair processes for equitable allocation of ICU resources.
    Posted 11/22/2021
     
• 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.
  Posted 5/4/20
   
• 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.
  Posted 7/31/20

Staffing

• 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.
  Posted 12/3/2020
   
• 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.

Personal Protective Equipment

• CDC: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
   
• OSHA: COVID-19 Healthcare ETS

Patient Care Strategies for Scarce Resource Situations

• 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.
  Updated February, 2024
   
• Adult Veno-Venous (VV) Extracorporeal Membrane Oxygenation (ECMO) Eligibility Criteria for COVID-19 ARDS (PDF)
  From the Minnesota ECMO Consortium.
  Updated 9/29/2021
   
• Pharmaceutical Shortages for Minnesota Hospitals (PDF)
  Frequently Asked Questions.
  Updated 6/1/20
   
• Recommendations for Ethical Allocation of Carboplatin and Cisplatin (PDF)
  A guide to care delivery and a basis for consistent response across Minnesota during the national shortage of these cancer drugs. 
  Posted 6/30/2023
   

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.

Minnesota Framework

The goal of the Minnesota CSC Framework is twofold:

1. To outline the Minnesota Department of Health response during a Crisis Standards of Care situation and
2. 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

Historical Overview

• 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.