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Crisis Standards of Care and COVID-19: What EMS Needs to Know
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Today► Crisis Standards of Care, EMS and the Law
► Minnesota EMS Crisis Standards of Care Plan
► The Local Perspective – Operationalizing Crisis Standards of Care
► Questions
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Today’s Speakers► James G. Hodge, Jr, JD, LLM
► Director, Center for Public Health Law and Policy, Arizona State University
► Professor, Sandra Day O’Connor College of Law
► Aaron Burnett, MD, FACEP► EMS Medical Director, State of Minnesota
► Associate Professor of Emergency Medicine, University of Minnesota
► John L. Hick, MD► Deputy Chief EMS Medical Director and Medical Director for Emergency
Preparedness, Hennepin County Medical Center
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Implementing Crisis Standards of Care in Response to COVID-19: Legal & Policy Issues
James G. Hodge, Jr, JD, LLM
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Purposes
► Emergency Declarations – Federal, State, Local
► Emergency Powers and Waivers
► Core Legal Issues
► Focus on Crisis Standards of Care Legal Concerns
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Multi-Level EmergenciesPublic health authorities, powers, liabilities and immunities vary depending on the type of emergency declared at each level of government
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8
HHS Public Health
Emergency
Stafford Act
Emergency
National Emergencies
Act
Defense Production
Act
Federal Emergencies/Invocations
January 31
March 13
March 13
March 20
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Select Emergency Waivers► EMTALA sanctions re: patient relocation
► HIPAA Privacy Rule regulations following implementation of hospital disaster protocol
► Licensure requirements for HCWs in the state where they are providing services
► Certain conditions of participation in Medicare, Medicaid and SCHIP
► Telehealth allowances to facilitate healthcare services and payments when visiting physical facilities
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Santa Cruz Co. 3/2Placer Co. 3/3
Marin Co. 3/3
Bellevue 3/3
COVID State & Select Tribal/Local Emergency Declarations
AK – Alaska
HI - Hawaii
PR - (Puerto Rico)
VI - (Virgin Islands)
San Diego Co. 2/19
San Fran City 2/25
Orange Co. 2/27
Solano Co. 2/27
2/29
Co. of Hawai’i 2/28
3/13/9
Seattle-King Co. 2/29
Clackamas Co. 3/2
Bexar Co. 3/2San Antonio 3/2
Sonoma Co. 3/2
Alameda Co. 2/19
Seattle 3/3
Santa Rosa 3/2
Redmond 3/3
Los Angeles Co. 3/4
Pasadena 3/4Long Beach 3/4
Lummi Nation 3/3
3/4
Washington Co. 3/4
Snohomish Co. 3/4
Emergency 3/4
Honolulu Co. 3/4Maui, Kaua’i 3/4
Click on the date of each state to view the declaration
Nevada Co. 3/4
Cowlitz Co. 3/4
Sacramento Co. 3/4
Edmond 3/5
Emergency - 33
Disaster - 4
Public Health Emergency/Disaster - 9
County/City
Emergency + Public Health Emergency - 4
Tribal
3/6
3/6
D.C. 3/11
Auburn 3/6Des Moines 3/6Mason Co. 3/6
3/6
Austin 3/6
3/6
Lexington (KY) 3/6
Eagle Co. (CO) 3/7
Travis Co. 3/6
Salt Lake Co. (UT) 3/6
3/73/8
Montgomery Co. (PA) 3/9
3/93/16
RI 3/9
3/5
3/9
Cooke Co. (IL) 3/9
Delaware Co. (PA) 3/9
3/9
Kitsap Co. 3/9
Miami-Dade Co. 3/11
3/10
3/4
3/10
Whatcom Co. 3/10
3/10
Pierce Co. 3/6
Houston 3/11
Salt Lake City (UT) 3/11
Cincinnati (OH) 3/11
3/11
3/11 3/11
3/11Public Health Disaster 3/11
Navajo Nation 3/11
Broward Co. 3/10
McHenry Co. (IL) 3/11
Northern Arapaho 3/11Oglala Sioux Tribe 3/11
3/12
3/12
3/12
Kansas City (MO) 3/12
3/12
New York City 3/123/12
3/12
Emergency 3/12
3/103/12
3/10
Cuyahoga Co. (OH) 3/12
NH3/13
VT 3/13
3/13
3/13
3/13
3/13
3/13
3/13
3/13
3/13
3/13 3/14
3/13
Emergency 3/13
3/14
3/15
St. Paul (MN) 3/15 Boston (MA) 3/15Milwaukee (WI) 3/13Minneapolis (MN) 3/16
Phoenix (AZ) 3/13
Umatilla Reservation 3/4
Hoopa Valley Tribe 3/4
Mendocino Co. 3/4
Santa Clara Co. 2/10
Los Angeles 3/4
DE3/12
3/9
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Emergency Powers AK
AZ
AR
CA
CO
CT
DE
FL
HI
IL
IN
IA
KY
LA
ME
MD
MA
MI
NJ
NM
NY
NC
OH
OR
PA
RI
TN
VA
UT
WA
WV
WI
Altered Contracts | Procurements
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Emergency Plans | ICS ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■Funding | Resource
Allocation■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Intrastate Coordination ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■Isolation | Quarantine ■ ■ ■ ■ ■ ■ ■Licensure Reciprocity ■ ■ ■ ■ ■ ■ ■
Price Controls re: Gouging ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Surveillance | Reporting ■ ■ ■ ■Testing | Screening |
Treatment■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Travel Restrictions ■ ■ ■ ■ ■ ■ ■ ■Waivers | Suspensions ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
This table tracks select, express authorities referenced via state emergency declarations (link on each state acronym for access). Additional emergency powers may be authorized under state law through which the declarations are issued.
Select State Emergency Powers
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Government
Actors
Partners
Laws
Legal Triage: Efforts of legal actors and others during declared emergencies to build a favorable legal environment by prioritizing issues and solutions facilitating legitimate public health responses
Legal Triage
Legal Triage in Emergencies
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Topics
Crisis Standards of
Care
Social Distancing Measures
Surveillance & Reporting
Privacy Liability & Insurance
Emergency Powers -
TriageTesting/ Screening/ Treatment
Emerging Legal Issues
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14
► Coordination► Allocation► Reimbursement► Licensure► Scope of Practice► Patient’s Interests► Duty to Care► Uniformity► Liability
Click on article image to access
CSC Legal Issues
CSC: substantial change in usual healthcare operations and level of care due to a pervasive or catastrophic disaster
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Prospective Civil Liability Claims
► Negligence/Malpractice► Intentional Torts► Privacy Infringements► Discrimination► Worker’s Compensation
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Umbrella of Liability Coverage
Despite risks, many legal liability protections apply in routine events and declared emergencies, especially concerning health care volunteers, workers and entities
16
Emergency Liability Protections – Health Practitioners & Entities
Good Samaritan Acts and
Entity Liability Protection
InsuranceCoverage
EMAC
FederalPREP Act
Indemnification
State VPA
State EHPA
Mutual AidAgreements
FederalVPA
MOUs
Joint Commission Standards/
Policies and Practices
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Acknowledgements
► Special thanks to Leila Barraza, JD, MPH, and Erica White at our Network -Western Region Office for their research and assistance
► Ask the Network re: questions/[email protected] | @jghodgejr
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Minnesota EMS Crisis Standards of Care Plan
Aaron Burnett, MD, FACEP
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Minnesota► Population 5.6 million
▷ 3.2 million in Twin Cities metro
► Level 1 Trauma Centers▷ 6 total (1 in across border in SD)
▷ 3 in Twin Cities
► Regionalized systems for:▷ Stroke
▷ STEMI
▷ Trauma
▷ Peds +/-
▷ Psych +/-
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Minnesota EMS Regulatory Board► Emergency Med. Physician
► Minn. Hospital Rep.
► Fire Chief
► Full-time Firefighter
► Volunteer Firefighter
► EMS Provider
► EMS Service Manager
► Minn. Sherriff Rep.
► Local Board of Public Health
► Regional EMS Program Reps. (2)
► Emergency Dept. RN
► Pediatrician
► Family Practice Physician
► Public Member
► OTHERS:▷ Commissioner of Public Safety Rep.
▷ Commissioner of Health Director Rep.
▷ State Senator
▷ State Representative
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Medical Direction Standing Advisory Committee“A forum for physicians to discuss
prehospital care and work toward the
improvement of medical direction
statewide. Its membership includes
physician members of the EMSRB, medical
directors from the eight EMS regional and
other interested emergency physicians”
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Minn. CSC Development► EMSRB and State Dept. of Health (MDH)
work independently but in partnership
► Crisis Standards of Care first developed in
2010 for H1N1
► Reviewed and endorsed by MDH as well as
EMSRB
► Unified front for patient care in Minn.
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Suspension of EMS RegulationsEmergency Suspension of Ambulance Service Requirements
Minn. Statute 144E.266
The requirements of the following statues are suspended in the geographic areas of the state affected during a governors declared peacetime emergency:
▷ 144E.10: Staffing, 24-hr response, BLS/ALS licensure, EVOC-drivers, PSA suspension, equipment
▷ 144E.121: Air ambulance licensure and staffing requirements
▷ 144E.123: Prehospital care data submission
▷ 144E.127: Interfacility transfer staffing requirements
▷ 144E.15: Relocating a base of operations
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The Local EMS Perspective: Operationalizing Crisis Standards of Care
John L. Hick, MD
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Hennepin Emergency Medical Services Crisis Contingency StrategiesDRAFT March 1, 2020
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MN Metro Region EMS System Pandemic Response MatrixApproved March 12, 2020 – EMS TOC Executive Committee
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Coronavirus/COVID-19 EMS Resourceswww.ems.gov/projects/coronavirus_covid-19_resources.html
Legal Emergency Preparedness Resourceswww.networkforphl.org/wp-content/uploads/2020/01/Western-Region-Emergency-Prep-8-23-18.pdf
Minnesota EMS Considerations – Crisis Standards of Carehttps://www.health.state.mn.us/communities/ep/surge/crisis/ems.html
Minnesota Suspension of Ambulance Service Requirement FAQshttps://mn.gov/emsrb/assets/Emergency%20Suspension%20Requirements%202020-03.19_tcm1116-423037.pdf
Questions?Please submit questions through the webinar platform
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Visit
for more info on COVID-19 and other
national EMS initiatives.
Thank You