However, not all programs are enabled for every disaster. The decision to approve programs is based on the types of support specified in the Governor`s or Tribal Chief`s application and the needs identified during the joint EPA and subsequent EPAs. FEMA`s disaster relief programs include: The letter`s report describes how changes to medical care standards during an emergency may not be reflected in the corresponding statutory standards of care, a separation that may result in a potential liability risk for health professionals. volunteers and institutions during their response efforts. Although standards of medical and legal care are often considered interchangeable, one view is that they are actually different concepts. From this perspective, standards of medical care describe the types and levels of medical care dictated by professional standards, professional requirements, and institutional goals (AHRQ, 2005; Hick et al., 2009; Pegalis, 2009). These standards of care vary (1) between different types of health care facilities such as hospitals, clinics and alternative care facilities (Hick et al., 2009); and (2) depending on the circumstances, including emergencies.1 While existing current standards of medical care are flexible, they do not reflect the guidelines needed to assist physicians attempting to allocate limited resources and make difficult decisions (including withholding or possibly withdrawing life-sustaining treatments) under difficult conditions in the event of a public health emergency. (GAO, 2008). Statutory standards of practice, on the other hand, can be defined as the minimum level of care and competence that a physician should provide in certain circumstances, based on what a reasonable and prudent physician would do in similar circumstances (Mastroianni, 2006).2 Legal standards of care are necessarily factually specific. flexible and subject to different interpretations by different courts (Dobbs, 2000).

They may reflect medical standards, but they don`t always do that. For example, previous tribunals assessing standards of care have sometimes found that the dominant medical practice was inadequate or unacceptable in exceptional cases.3,4 In these cases, physicians have been held accountable for their actions, even if they were consistent with prevailing standards of medical care due to the circumstances. The Stafford Act provides for two types of disaster declarations: emergency declarations and major disaster declarations.2 Both types of declarations authorize the President to provide additional federal disaster relief. However, the events surrounding the two different types of reporting, as well as the scope and level of support, differ. This information is included in the request of the governor or tribal chief to demonstrate that the disaster is of such severity and magnitude that an effective response is beyond the capacity of the affected state and local governments or the Indian tribal government, and that additional federal assistance is required. However, the extent of legal discrepancies in emergency situations depends on the type of emergency declared. The federal government, any state, many territories, and some local governments may declare “states of emergency” or general “disasters” in response to public health crises (Hodge & Anderson, 2008). These declarations broadly empower civil protection authorities and others to use general legal powers to coordinate emergency response.

The Department of Health and Human Services (HHS) and more than half of the states can also declare a “public health emergency” (Hodge et al., 2008), which is based in part on the Model State Emergency Health Powers Act (Centers for Law and the Public`s Health, 2001).7 Together, these declarations authorize a set of accelerated public health powers. coordinated by health authorities in collaboration with emergency managers and other partners. The federal government and some states can declare both an “emergency” or “disaster” and a “public health emergency” in response to the same incident as during Hurricane Katrina and the 2009 H1N1 pandemic. These dual explanations can be confusing, as different governments and government actors attempt to respond in overlapping and potentially inconsistent ways (Hodge and Anderson, 2008). The governor of the affected state or tribal leader of the affected tribe must submit a request to the president through the appropriate regional administrator within 30 days of the incident. The request must be based on the determination that the situation is beyond the capacity of the affected state and local governments or the Indian tribal government and that additional emergency federal assistance is needed to save lives and protect public property, health and safety, or to reduce or avert disaster risk. In addition, the application must include the following: Typically, the ADP is completed before the governor or tribal chief`s application for a major disaster declaration is submitted. However, if an obviously serious or catastrophic event occurs, the Governor or Tribal Chief`s request may be made prior to the completion of the EPA.1 In such circumstances, the major disaster is generally limited to public assistance categories A and/or B (which may be limited to direct federal assistance (DFA)) and risk mitigation assistance. For high-impact events where the extent of damage to housing is empirically overwhelming, the statement may also include individual support. Other forms of support may be added at a later date until the EDIs are completed.

Despite concerns about liability in emergencies, there is no comprehensive national liability protection for health professionals or facilities in all areas. Instead, a range of liability protections at all levels of government covers practitioners and entities, particularly volunteers, government agencies and public servants, who act in good faith and without willful fault, gross negligence or recklessness (Hoffman, 2008; Hoffman et al., 2009; Rosenbaum et al., 2008; TFAH, 2008). Similar to the protections afforded to emergency managers, police, firefighters and other responders, emergency liability protection in all states can immunize or compensate public health and health care actors or institutions from certain claims or financial damages. Suspension of federal or state legal requirements or lifting of penalties for non-compliance with certain federal or state laws during declared emergencies may provide additional protection.13 Certain liability protection provisions, including Good Samaritan Bylaws (HHS ASPR, 2009), volunteer protection laws,14 15 and tort claims,16 may apply outside of a declaration of emergency. Other protective measures, such as those provided by EMAC17 or emergency laws, are triggered only by a declaration of emergency (Centers for Law and the Public`s Health, 2004). Table 3-2 lists specific legal or regulatory formulations that currently provide different levels of liability protection for health professionals, volunteers and institutions. “Under the EMAC, a person of a State who provides assistance in another State and who holds a licence, certificate or other authorization to exercise professional, mechanical or other competence shall be deemed to hold a licence, certification or authority to perform such functions in the requesting State, subject to any restrictions or conditions established by the Governor of the requesting State.” However, reciprocity of authorization is not automatically extended to volunteer health professionals who do not provide services in accordance with a request for assistance from EMAC (Congressional Research Service, 2009). As mentioned above, liability risk is a major concern for healthcare professionals and institutions. CSC implementation is a dynamic process that involves difficult decisions, intense trade-offs, constant evaluations of certain action plans, and potentially unconventional actions (including denial or interruption of health services due to limited resources).