National preparedness for a catastrophic emergency: crisis standards of care.

PUBLIC HEALTH EMERGENCIES UNDERSCORE THE IMMEdiate and crucial need to plan for a mass disaster in which tens or even hundreds of thousands of individuals suddenly require medical care. On October 24, 2009, President Obama declared a public health emergency in response to influenza A(H1N1), but natural disasters (eg, hurricanes, floods, or earthquakes) and terrorism acts (eg, anthrax or a nuclear detonation) similarly demonstrate the critical need for national preparedness. Public health emergencies evoke troubling questions with life-or-death consequences. Which patients should receive limited resources and who decides? Should professional standards of care change and if so, what are the catalysts? Should the law grant civil or criminal immunity to professionals acting in good faith? Hurricane Katrina is a galvanizing point for answering such difficult questions, so gaining the public’s trust is vital.