Zlatina A.A., Bulycheva O.S.
When crisis care becomes necessary, a threshold has been crossed requiring that the affected institution(s) either quickly address the situation internally, or, more likely, appeal to partner facilities and agencies for assistance in either transferring patients to facilities with resources or bringing needed resources to the facility. If these strategies cannot be carried out, or if partner facilities are in the same situation, then systematic implementation of crisis standards of care at the state level may become necessary in order to codify and provide guidance for triage of life-sustaining interventions as well as to authorize care provided in non-traditional locations (alternate care facilities). The state has an obligation to ensure consistency of medical care to the highest degree possible when crisis care is being provided. Usual coordination and resource requests outlined above are used to minimize healthcare service disruption and/or to provide the most consistent level of care across the affected area and the state as a whole. When prolonged or widespread crisis care is necessary, the state should issue a declaration or invoke emergency powers empowering and protecting providers and agencies to take necessary actions to provide medical care and should accompany these declarations with clinical guidance, developed by the State Disaster Medical Advisory Committee, to provide a consistent basis for life-sustaining resource allocation decisions. The state, through its emergency powers, resource allocation, and provision of clinical guidance, attempts to “level the playing field” at the state level, as well as provide legal protections for providers making difficult triage decisions and provide relief from usual regulations that might impede coping strategies such as alternate care facilities. Some hospital coalitions cover large metropolitan areas and thus the Regional Medical Coordination Center (RMCC) acts as liaison between the state and its constituents. The RMCC may be an agency, such as public health, or a hospital or other facility designated by the system. The RMCC attempts to ensure regional medical care consistency and may do so by acting as a resource “clearinghouse” between the healthcare facilities and emergency management and coordinating policy and information to meet regional needs. This may involve a Regional Disaster Medical Advisory Committee or at least a medical advisor or coordinator with access to technical experts in the area, particularly in large metropolitan areas because the specific needs of the area may not be well addressed by state guidance. However, the regional guidance cannot be inconsistent with that of the state. Individual hospitals and healthcare facilities should work through tactical mutual aid agreements with other local facilities and at the regional level to ameliorate conditions that might force crisis standards of care.
Поройский С.В., Доника А.Д. Кафедра медицины катастроф Волгоградского государственного медицинского университета: вчера, сегодня, завтра. Медицина катастроф. 2016. № 2 (94). С. 48-53.
Булычева О.С., Доника А.Д., Чеканин И.М. Профессиональная подготовка медицинских кадров и специалистов Всероссийской службы медицины катастроф. Международный журнал экспериментального образования. 2016. № 4-3. С. 484.