Opportunities for Strengthening and Updating Crisis Standards of Care
When hospitals faced the worst of the COVID-19 pandemic, many quietly adapted how they delivered care without ever formally declaring a crisis. Protocols designed to guide difficult decisions during mass casualty events were bypassed, misunderstood, or simply left to individual clinicians at the bedside. A new expert consultation examines what went wrong and what needs to change before the next large-scale emergency.
The National Academies of Sciences, Engineering, and Medicine will host a virtual public briefing on Thursday, September 3, 2026, from 11:00 AM to 12:00 PM Eastern Time. The session will present and discuss findings from a recently released rapid expert consultation, Updating Crisis Standards of Care: Examining Gaps and Opportunities, produced in response to a request from the Administration for Strategic Preparedness and Response (ASPR).
Crisis standards of care refer to a systematic approach for adapting health care delivery when patient demand exceeds available resources. These frameworks, first developed by the National Academies in 2009 and expanded in 2012, were put to the test at scale for the first time during COVID-19. The findings of the new consultation are pointed: the ethical foundations underlying these frameworks held up, but the operational side fell short in ways that carry direct implications for future emergency preparedness.
Among the consultation’s central findings is that the three steps expected to define a crisis response, recognizing that a crisis exists, formally activating a plan, and implementing crisis-level strategies, often did not occur in sequence. Hospitals adopted crisis-level approaches without issuing formal declarations. States largely left activation decisions to individual facilities. Frontline clinicians were frequently left to make high-stakes allocation decisions without institutional backing or clear legal protection. The result, the report finds, was lasting moral distress and burnout among health workers that outlasted the pandemic itself.
The consultation also identifies regional coordination as both a critical gap and a meaningful opportunity. States including Washington, Minnesota, and Arizona established Medical Operations Coordination Centers during the pandemic to manage patient transfers and balance load across hospitals. Evidence suggests these centers may have prevented a measurable share of excess deaths during surge periods. Yet many were shut down after the immediate crisis passed, largely due to funding constraints and unresolved questions about long-term governance.
The briefing is relevant for health security professionals thinking beyond infectious disease. The consultation addresses how crisis standards of care frameworks must also account for mass casualty events such as nuclear accidents, high-consequence infectious disease outbreaks requiring complex isolation and transport capacity, and infrastructure failures such as cyberattacks that can cripple hospital pharmacy and diagnostic systems without any increase in patient volume.
The report points to several priorities for the field: clearer operational guidance, stronger decision-support tools, more robust regional coordination infrastructure, and flexible frameworks for workforce mobility. These are investments the consultation argues should be made before the next emergency, not in response to it.
A related analysis of these findings, covering the lessons from COVID-19 and the emerging gaps in health system preparedness, is available in the Global Biodefense article Crisis Standards of Care: Lessons from COVID-19 and Emerging Gaps in Health System Preparedness.
For more information and to register, please visit Opportunities for Strengthening and Updating Crisis Standards of Care Public Briefing.
This content was researched and sourced by Global Biodefense editors and reported with Claude AI assistance for drafting and editing.