Allocation of Scarce Resources in a Pandemic: A Systematic Review of U.S. State Crisis Standards of Care Documents

OBJECTIVE: To locate and analyze U.S. State Crisis Standards of Care (CSC) documents to determine their prevalence and quality. METHODS: Following PRISMA guidelines, Google search for "allocation of scarce resources" and "crisis standards of care (CSC)" for each state. We analyzed the plans based on the 2009 Institute of Medicine (IOM) Report which provided guidance for establishing CSC for use in disaster situations, as well as the 2014 CHEST consensus statement's 11 core topic areas. RESULTS: The search yielded 42 state documents and we excluded 11 that were not CSC plans. Of the 31 included plans, 13 plans were written for an "All Hazards" approach, while 18 were pandemic influenza specific. 18 had strong ethical grounding. 21 plans had integrated and ongoing community and provider engagement, education, and communication. 22 had assurances regarding legal authority and environment. 16 plans had clear indicators, triggers, and lines of responsibility. Finally, 28 had evidence-based clinical processes and operations. CONCLUSION: Five plans contained all 5 IOM elements: Arizona, Colorado, Minnesota, Nevada, and Vermont. Colorado and Minnesota have "All Hazards" documents and processes for both Adult and Pediatric populations and could be considered exemplars for other states.