EXPLAINER: What are 'Crisis Standards of Care?'

1 / 3Virus Outbreak HospitalFILE – In this Aug. 31, 2021 file photo a R.N. holds the hand of a COVID-19 patient in the Medical Intensive care unit (MICU) at St. Luke’s Boise Medical Center in Boise, Idaho. The Idaho Department of Health and Welfare made the announcement Thursday, Sept. 16, 2021. St. Luke’s Health System, Idaho’s largest hospital network, asked state health leaders to allow “crisis standards of care” on Wednesday because the increase in COVID-19 patients has exhausted the state’s medical resources. (AP Photo/Kyle Gree,File)

BOISE, Idaho (AP) — As the spread of the delta variant continues unabated in much of the U.S., public health leaders have approved health care rationing in Idaho and parts of Alaska and Montana.

At least five more states — Georgia, Kentucky, Mississippi, Arkansas and Texas — are nearing capacity with more than 90% of their intensive care unit beds full, according to data from the U.S. Department of Health and Human Services.

The move to ration healthcare comes amid a spike in the number of unvaccinated COVID-19 patients requiring hospitalization. Crisis standards of care allow health care providers to give scarce resources, like ventilators, to the patients most likely to survive.

But determining who gets what is no easy feat.


Crisis standards of care give legal and ethical guidelines to health care providers when they have too many patients and not enough resources to care for them all. Essentially, they spell out exactly how health care should be rationed in order to save the most lives possible during a disaster.

Some health care rationing steps have become commonplace during the pandemic, with hospitals postponing elective surgeries and some physicians switching to online visits rather than seeing patients in person. But more serious steps — such as deciding which patients must be treated in a normal hospital room or intensive care unit bed, and which patients can be cared for in a hospital lobby or classroom — have been rare.

At the extreme end of the spectrum, crisis standards of care generally use scoring systems to determine which patients get ventilators or other life-saving medical interventions and which ones are treated with pain medicine and other palliative care until they recover or die.


States may use a combination of factors to come up with patient “priority scores.” Idaho's and Montana 's system both consider how well a patient's major organ systems are functioning. Patients with indications of liver or kidney damage, poor oxygen and blood clotting levels and an inability to respond to pain because they are in a coma have higher scores.

Both states also score people based on saving the highest number of “life-years,” so if a person has cancer or another illness that is likely to impact their future survival, they get a higher score.

The lower a patient's score, the more likely they are to survive, moving them toward the front of the line for ventilators or other resources.

The plans also have “tie-breakers” that come into play if there aren't enough resources for all of the folks at the front of the line. Youth is the biggest tie-breaker, with children getting top priority.

In Idaho, pregnant women who are at least 28 weeks along with viable pregnancies come next. Both states also give consideration to younger adults ahead of older adults, and Idaho's fourth tie-breaker is if the patient performs a task that is vital to the public health crisis response. The final tie-breaker is a lottery system.

If someone at the front of the line is given a ventilator and doesn't show improvement within a set period of time, Idaho says they should be taken off so someone else can have a chance.

On Thursday, shortly after Idaho enacted crisis standards of care statewide, Dr. Steven Nemerson with Saint Alphonsus Regional Medical Center in Boise said that to his knowledge, no patient in the state had been removed from life support in order to provide the equipment to someone else. But he warned it would happen.

“It’s bad today. It’s going to get much worse,” Nemerson said. “I’m scared for all of us.”



In both Idaho and Montana, the crisis standards of care don't consider whether a person has been vaccinated against COVID-19. Likewise, patients aren't denied care if they are injured in a car accident because they failed to wear a seatbelt or drove while intoxicated.

“Vaccination status is not relevant to us when it comes to taking care of patients. We simply do what they need us to do within the constraints and the resources that we have,” said Dr. Shelly Harkins, chief medical officer at St. Peters hospitals in Helena.


Nearly everything.

People will likely wait longer for care, not just in hospitals but at urgent care centers that will likely be dealing with more patients as well. Nurses will care for more patients than they normally would. Instead of hospital beds, some people might be placed on stretchers and cots. Patients will likely be sent home from the hospital as soon as possible, relying on friends, family and prescriptions for in-home medical equipment during their recovery.

And in some cases, physicians may not attempt to save a patient's life at all. Idaho's crisis standards of care plan calls for a “Universal Do Not Resuscitate Order” for all adults once the state has reached the point where there aren't enough ventilators to go around.

That means if a patient experiences cardiac arrest — where the heart stops suddenly — there will be no chest compressions, no attempts to shock the heart back into a normal rhythm, no chance at hooking them up to life support. That's partly because resuscitation requires a bunch of hospital staffers, a lot of time, and is frequently unsuccessful. It's also because if the patient has COVID-19, the process of attempting to revive sends aerosolized virus particles into the air, putting staffers at risk.

Montana's plan is a bit different, in that it allows individual doctors to decide whether or not to resuscitate patients on a case-by-case basis.


Talk to a health care provider in Idaho, and you're likely to hear the phrase “moral injury,” a term that means the emotional trauma that health care providers experience when they lose a patient or are faced with being unable to provide life-saving treatment. Ideally, crisis standard of care plans reduce moral injury, but they are far from perfect.

Dr. Matthew Wynia, a University of Colorado professor of medicine and health ethics expert, said state authorities should be responsible for establishing strategies needed to make triage decision fairly, so doctors and nurses aren't left making those calls on their own at a patient's bedside.

That means making sure that transfer systems are in place and working well so that one hospital isn't making tragic decisions because they are out of a resource that is available at another facility, he said.

When facing critical shortages of staff or equipment, “You really can’t say (to patients or their families), ‘Would you like to go to the ER?’ You have to go to the patient and say, ‘We can’t do it,’ which is an incredibly hard situation,” Wynia said.

“There’s no way to look at this and say this is OK. It’s not OK,’’ he said. But it’s necessary if hospitals are running out of resources, “which is happening right now,’’ Wynia said.


Health experts say getting vaccinated is the best way to protect against needing hospitalization because of coronavirus. Idaho's hospital crisis is caused primarily by a massive increase in the number of coronavirus patients needing hospital care, Idaho Department of Health and Welfare Director Dave Jeppesen said Thursday.

The Idaho Department of Health and Welfare is also advising people to be extra careful in every aspect of daily life, by wearing seatbelts, taking medications as prescribed and avoiding high-risk activities like mountain biking until the crisis has passed.


Lindsey Tanner contributed to this report from Chicago. Iris Samuels contributed to this report from Helena, Montana. Samuels is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

Internet Explorer Channel Network
News Related


What is salmonella and what are the symptoms?

SALMONELLA has key signs for detection once it enters the human body. The Centers for Disease Control announced on October 20, 2021, that people across 37 states had a salmonella ... Read more »

Phase 2 Trial On Ayahuasca's Active Ingredient Puts Small Pharma On Track To Winning The Psychedelics Race

© Provided by Benzinga Small Pharma Inc. (OTCQB: DMTTF) (TSXV: DMT), a biotech company focused on psychedelic therapies, has begun its phase 2a clinical trial on SPL026. SPL026 is a ... Read more »

The FDA just authorized booster shots of Moderna's and Johnson & Johnson's COVID-19 vaccines and is letting users mix and match shots

© Provided by Business Insider An employee of Japan’s Suntory Holdings receives the Moderna coronavirus vaccine for Covid-19. KAZUHIRO NOGI/AFP via Getty Images The FDA authorized booster shots of the ... Read more »

‘Untethered' judge causes pain for pharmacies that filled legal painkiller prescriptions

No matter how often plaintiffs’ attorneys and leftist activists pretend otherwise, it is insanely unfair to blame the opioid epidemic on pharmacists filling otherwise valid prescriptions from licensed physicians. © ... Read more »

GPs refuse to dish out booster jabs ‘as they're too busy with other jobs'

DOCTORS are refusing to dish out booster jabs — claiming they are too busy with other jobs. Family doctors say they can’t deal with routine appointments and top-up vaccines as ... Read more »

Parents in Michigan, Virginia sue DOJ over response to school board threats

A lawsuit accuses Attorney General Merrick Garland of trying to criminalize free speech by ordering a review of threats made against school personnel. Read more »

Vulnerable OAP, 92, finally gets her booster thanks to Give Britain A Booster campaign

SOME Sun readers have struggled to get boosters despite being eligible. The NHS booking service will not allow appointments without an invitation. Vulnerable Irene Turi, 92, could not secure her ... Read more »

FDA OKs Moderna, J&J boosters, along with 'mix and match' approach

The move will greatly expand access to booster shots. Read more »

Sajid Javid begs Brits to get their Covid booster jabs or face return to resitrctions

SAJID Javid begged Brits last night to get their booster vaccinations or face a return to Covid restrictions. The Health Secretary, backing The Sun’s Give Britain a Booster campaign, warned ... Read more »

Heart health key to Type 2 diabetes prevention: researchers

Heart health is a key component to the prevention of Type 2 diabetes, according to researchers.  In a September study published in the European Journal of Preventive Cardiology, Netherlands scientists ... Read more »

Can My Dog Eat Spicy Food?

Some spicy foods are so good that it’s tempting to sneak your dog a bite. But can dogs eat spicy food? And do they even like it? Not all spicy ... Read more »

Slow Sales of Alzheimer's Drug Costing $50K a Year Partially Blamed on Supply Chain Issues

Biogen’s new Alzheimer’s drug, Aduhelm, brought in an unexpectedly low $300,000 in sales during its first full quarter on the market. The company blamed the tepid debut on coverage questions ... Read more »

Democrats weigh vouchers for Medicare dental benefits amid funding squeeze

Congressional Democrats looking to cut at least a trillion dollars from their social spending package are considering converting one of the most expensive health care pieces — dental benefits for ... Read more »

This New Nasal Swab Test Can Predict Whether COVID Patients Will Be Hospitalized

For nearly two years, public health systems have been playing a game of Russian roulette when it comes to severe COVID-19. Some people get extremely sick or die. Others escape ... Read more »

Blunt praised for medical research funding during dedication of University of Missouri facility

Administrators, scientists and politicians praised U.S. Sen. Roy Blunt on Tuesday for years of securing medical research funding while dedicating the NextGen Precision Health facility in his name on the ... Read more »

Nation's vaccine experts debate goal of booster campaign

Are boosters meant to prevent infections? Or to keep people out of the hospital? Read more »

Fact check: Are smokers at less risk for contracting the coronavirus?

The claim: Nicotine substitutes could have a positive effect in fighting COVID-19 Amid coronavirus news, claims have surfaced that nicotine could contribute to preventing people from contracting COVID-19. This followed ... Read more »

Vaccine breakthrough! Needle-free flu jab could suppress winter crisis

British biotech firm Enesi Pharma announced it will begin clinical trials to help contain the outbreak of a ‘super cold’. Enesi Pharma joined forces with National Institutes of Health (NIH) ... Read more »

Feeling anxious? Here are our top picks for apps to help calm your inner panic

March 2020 marked the beginning of change – and not in a good way. No longer could we distract our minds by throwing ourselves into socialising or work. The gym ... Read more »

St James Quarter's Bonnie & Wild hosts Champagne tasting event, running alongside Seafood Week treats

Partner oysters with a couple of different fizz brands © Bonnie & Wild They say real pain for your enemies, Champagne for your friends. Thus, make a date to celebrate ... Read more »

Alandas opens gelato shop in historic Edinburgh building that was once Greyfriars Bobby's lunch spot

© Alandas gelato “One of the most noticeable and arguably most challenging differences between ice-cream and gelato is the way it is served”, says Carla Black, head of marketing and ... Read more »

Cavity-Prone? A Dentist Explains Why You Should Be Careful About Mouthwash

© Photo: Stocksy/ Milles Studio Side view of black female in sleepwear using toothbrush to clean teeth while looking at mirror in modern bathroom in morning. The rules of good ... Read more »

Don't Write Off Vaxart, As Its Oral Vaccine Still Has a Chance

© Source: Ascannio / Shutterstock.com VXRT stock First off, it makes sense why many may be skeptical about Vaxart (NASDAQ:VXRT). One of the lesser-known Covid-19 vaccine companies, VXRT stock has seen ... Read more »

Meghan Markle is urging Democratic leaders in Congress to support for paid family and medical leave

© WPA Pool/Getty Images WPA Pool/Getty Images Meghan Markle urged Democratic leaders in a letter Wednesday to support paid family and medical leave. The letter comes as Biden’s paid leave ... Read more »

COVID vaccine rollout for kids under 12: What to know

Pfizer’s COVID-19 vaccine is expected to be authorized and recommended for kids ages 5-11 in early November, and the Biden administration “will be ready to begin getting shots in arms ... Read more »

Scientists search for cause of mysterious Covid-related inflammation in children

More than 5,200 of the 6.2 million U.S. children diagnosed with Covid have developed MIS-C, or multisystem inflammatory syndrome. Read more »

Is It Safe to Trick-or-Treat This Year? Expert Advice for Celebrating Halloween During COVID

© Provided by Health Getty Images In fall 2020, when masks were already mainstream but vaccines were just a pipe dream, the scariest part about Halloween was the prospect of ... Read more »

How to Stay Connected to Your Loved One in a Nursing Home

We all need to feel connected to the outside world. For people living in nursing homes, staying in touch has always been more of a challenge, particularly with family members ... Read more »

Ending the opioid crisis starts with proper distribution of settlement payouts

The opioid crisis is an ever-present and increasingly deadly epidemic impacting the lives of families in every community across America. The BAD news is that 2020 saw a devastating increase ... Read more »

TODAY ONLY: 5 Grooming & Beauty Deals You Need to Know About From Amazon

© Courtesy of Amazon Shaving your face? Brushing your teeth? We’re absolutely sure of it — we aren’t living in the 1800s. But maybe your toothbrush is getting a little ... Read more »

Abbott Laboratories (ABT) Q3 2021 Earnings Call Transcript

© Provided by The Motley Fool Abbott Laboratories (ABT) Q3 2021 Earnings Call Transcript © The Motley Fool Logo of jester cap with thought bubble. Abbott Laboratories (NYSE: ABT) Q3 2021 Earnings ... Read more »

Jennifer Garner Stays Fit and Glowing Thanks to Her Amazing Wellness Routine

Jennifer Garner reveals her top wellness practices, like exercising and meditating. The actress also opened up about her skincare routine and the importance of wearing sunscreen. Garner stays social and ... Read more »

The US Is Getting Ready to Start Vaccinating Kids Ages 5–11 Against COVID-19—Here's How

© Provided by Health Getty Images If you’ve been waiting for news on a kids’ COVID vaccine, you might at least take comfort in the newest information that dropped today: ... Read more »

This Dietitian Explains 3 Things You Can Do to Reduce Cravings, and It's Not Just "Drink Water"

© Getty / Westend61 This Dietitian Explains 3 Things You Can Do to Reduce Cravings, and It’s Not Just “Drink Water” Craving your favorite foods, even after you’ve eaten a ... Read more »

'Flu could be a real problem' Britons urged to get flu jab to avoid UK sickness storm

The health secretary has warned that cases of influenza could soar this winter, as a result of strict coronavirus measures that reduced the number of cases during the 2020-21 season. ... Read more »

Exclusive: Dia Mirza On Gardening In A Concrete Jungle & Getting Off The Treadmill Of Anxiety

Author: Dia Mirza, Actor, UN Environment Goodwill Ambassador, and United Nations Secretary-General Advocate for Sustainable Development Goals and Global Ambassador IFAW Former Miss India and Miss Asia Pacific, actor Dia ... Read more »

Back in society with good teeth

Groningen Thanks to a collaboration between the Municipality of Groningen, the Center for Dentistry and Oral Hygiene of the UMCG (UMCG-CTM) and Menzis, clients of Addiction Care North Netherlands (VNN) ... Read more »

Mom who shared heart-wrenching pic of son battling cancer has a happy update

In 2019, Texas mom Kaitlin Burge shared a gut-wrenching photo to illustrate how childhood cancer impacts the whole family. In the image, Kaitlin’s son Beckett, who was battling acute lymphoblastic ... Read more »

How States Could Reach Herd Immunity As Delta Variant Continues To Dominate

Cautious optimism has been voiced from some states that they may be approaching herd immunity against COVID. © Pablo Monsalve/VIEW press / Getty People cross a road in New York ... Read more »

Biogen inc (BIIB) Q3 2021 Earnings Call Transcript

© Provided by The Motley Fool Biogen inc (BIIB) Q3 2021 Earnings Call Transcript © The Motley Fool Logo of jester cap with thought bubble. Biogen inc (NASDAQ: BIIB) Q3 2021 Earnings ... Read more »
On free-english-test.com you will find lots of free English exam practice materials to help you improve your English skills: grammar, listening, reading, writing, ielts, toeic