Preparing for Emergencies Requires Better Communication, Says GAO

Janice Simmons, for HealthLeaders Media , January 26, 2010

Though hospitals have improved efforts to prepare for so-called "surge" demands posed by mass casualty events, the Government Accountability Office (GA0) found the federal government can provide more assistance to make sure every state is on the same page when these emergencies occur.

In a June 2008 report, GAO found that only three states in a sampling of 20 states had developed and adopted guidelines for using "altered standards of care" in case of a medical surge of patients or mass casualty event, such as a flood or terrorist act.

At the time, the Department of Health and Human Services (HHS) had provided broad guidance that established a framework and principles for states to use when developing their guidelines for altered standards of care. However, because of the difficulty in addressing the related medical, ethical, and legal issues, it was a while before many states could develop such guidelines because they lacked resources, such as ventilators, to care for large numbers of people were available.

In a mass casualty event, the guidelines would be "a critical resource for medical providers" who may have to make repeated life-or-death decisions about which patients get or lose access to these emergency resources, GAO said.

Additionally, these guidelines can help address medical providers’ concerns about ethics and liability that may occur when negative outcomes are associated with their decisions, GAO said. In its role of assisting states’ efforts to plan for a medical surge, HHS has not been collecting altered standards of care guidelines that various states and medical experts had developed to make them available to other states.

If a mass casualty event occurs, GAO said, "difficult choices" will have to be made, and "the more fully the issues raised by such choices are discussed prior to making them, the greater the potential for the choices to be ethically sound and generally accepted."

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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