Summary: More than four years after the start of the COVID-19 pandemic, many states in the United States have not approved a framework for the ethical allocation of scarce medical resources and/or the invocation of Crisis Standards of Care (CSC) in their state emergency operations plans. This report discusses a pragmatic approach to socialization of and education about such a guidance document, through structured tabletop exercises for leaders of regional Healthcare Coalitions (HCCs) in the State of Michigan. In Michigan, the State Disaster Medical Advisory Committee revised previous state guidance on the ethical allocation of scarce medical resources during the pandemic. Revisions included a more nuanced use of scoring systems predictive of mortality (some of which have been deemed potentially disadvantageous to certain racial groups), consideration of the perspectives of the disability community, and a greater emphasis on the ethical duty to plan so that CSCs need not be invoked. Detailed presentations to Regional HCCs were conducted throughout the state, immediately followed by a structured tabletop exercise (TTX) that allowed HCC members to work through a scenario (a critical blood product shortage) using ethical guidance alongside practical aspects of emergency management and health system operations. Identical conferences occurred for both urban and rural HCCs. This state-endorsed ethical and legal framework was presented by the legal expert (co-author LG), followed by practical applications by a hospital executive preparedness expert (co-author ML). HCC’s emergency management and medical leaders practiced how the critical shortage would impact their region using the framework’s principles within the construct of their emergency operation plans. This method of amplifying state guidance with concomitant TTX could provide a superior educational tool for those tasked with responding to critical scarcity events.
Lozon et al. (Sun,) studied this question.