How did Idaho activate crisis standards of care in North Idaho? Who will get treated?
For over two weeks, Idaho officials and health care professionals have sounded the alarm about the COVID-19 surge, warning residents that the state is on the brink of implementing crisis standards of care. North Idaho is now past that brink.
Kootenai Health in Coeur d’Alene requested that the crisis standards be implemented. The Idaho Department of Health and Welfare decided Monday to implement the standards regionally, in North Idaho, where a wave of COVID-19 patients has overwhelmed health care capacity.
The crisis standards, created in June 2020, are a plan to ration health care if hospitals are overwhelmed due to a disaster. A committee of medical administrators, providers and public health professionals decided on the plan that will now determine how patients get treated in at least one region of the state.
If more Idaho residents don’t get vaccinated against COVID-19, Idaho health officials warned, the crisis standards could spread to a statewide measure.
North Idaho has a “severe shortage of staffing and available beds,” according to an Idaho Department of Health and Welfare news release.
“This is a decision I was fervently hoping to avoid,” Dave Jeppesen, IDHW director, said in a statement Tuesday. “The best tools we have to turn this around is for more people to get vaccinated and to wear masks indoors and in outdoor crowded public places.”
How does Idaho implement crisis standards of care?
Jeppesen told the Idaho Statesman on Friday that it takes only one hospital to make the request to implement crisis standards of care for the state to begin its process. Implementing crisis standards can help provide a legal defense to a hospital if it were to face a lawsuit, Jeppesen said.
State officials are relying on hospitals to give them the signal that they need crisis standards implemented, Jeppesen said.
“We’re really looking to the hospitals to be the ones to judge that they’ve tipped from contingency care to crisis standards of care,” Jeppesen told the Statesman. “It just takes one of them to say, ‘Yes, we’re monitoring this minute by minute, and we’ve passed that threshold.’ ”
Kootenai Health gave that signal. Facing a shortage of staffing and beds, the North Idaho hospital said all other contingency measures — steps taken to prevent crisis standards — were exhausted. The hospital reached the point of requesting crisis standards even after Gov. Brad Little sent a 20-person medical team from the Department of Defense to North Idaho.
At least three hospitals as of Friday had requested additional staff offered by Little, Jeppesen said. He declined to name them. Whether that staffing will be enough to stave off crisis standards in other parts of the state remains unclear.
Jeppesen and Elke Shaw-Tulloch plan to get on the phone with the hospital within 30 minutes of a crisis standards request, he said. After that, they expect to assemble the activation committee within one or two hours to determine whether it is time to implement the crisis standards.
The committee convened Monday and decided to implement the standards regionally, in North Idaho.
How do hospitals decide which patients to prioritize?
On a typical day at the hospital, health care is prioritized for the person who is worst off and needs it most. Crisis standards change that. Instead, health care is provided to the patient most likely to survive.
The plan is to try to “maximize the number of lives saved,” said Shasta Kilminster-Hadley, a former attorney for the Idaho State Board of Medicine who teaches health care law at the University of Idaho. Kilminster-Hadley was also a contributor to the crisis standards in June 2020.
Public health officials have emphasized that crisis standards don’t just affect COVID-19 patients. Someone who gets in a serious car accident, for example, would be scored in the same way a COVID-19 patient would be.
When crisis standards are implemented, hospitals follow a triage protocol. That includes giving patients a Sequential Organ Failure Assessment score to predict survival. The highest-priority patients are those who have a life-threatening illness or injury, but can make it out of the hospital.
During a crisis, “we’re going to look at patients around you who need to be admitted, and we’re going to try to do the best good for the greatest number of people,” Kilminster-Hadley said. “So we’re going to treat the people that we think we can save, versus people who we think have a lower chance of surviving.”
The standards also can help protect hospitals from liability, though they don’t provide immunity, Kilminster-Hadley said. To have liability for medical malpractice, she said, the plaintiff must make a case based on the community standard of care at that time — and if crisis standards were implemented, the standard is different.
State public health officials on Friday said they’re in uncharted territory. The state has never reached this point in the coronavirus pandemic before, and hospitals and health care systems are still learning to respond to the emergency as they go.
Dr. Marcia Witte, a St. Luke’s physician and contributor to crisis standards, said the state is still fine-tuning the process.
“It’s building the airplane as we fly, to some extent,” Witte said.
Have other states done this?
The coronavirus pandemic spurred several other states to craft their own crisis standards of care. Some of them implemented their plans as early as last year.
Arizona was one of the first to implement its crisis care standards in July 2020, when intensive care units were nearly full and in-patient beds were at a record high. Colorado also implemented its plan specifically for personal protective equipment and emergency medical services in April 2020. New Mexico activated its crisis standards in December 2020.
This story was originally published September 7, 2021 at 11:36 AM.
