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Welcome!

Welcome!. Wendy Smith-Reeve. Agency Mission. Department of Emergency and Military Affairs The Department’s mission is to provide military and emergency management capabilities to citizens of Arizona and the Nation. Whole Community.

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Welcome!

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  1. Welcome!

  2. Wendy Smith-Reeve

  3. Agency Mission Department of Emergency and Military AffairsThe Department’s mission is to provide militaryand emergency management capabilities to citizens of Arizona and the Nation

  4. Whole Community

  5. Berkowitz, Bonnie, Chris Alcantara, and Denise Lu. 2019. “Analysis | More than 50 Years of U.S. Mass Shootings: The Victims, Sites, Killers and Weapons.” The Washington Post. WP Company. September 4. https://www.washingtonpost.com/graphics/2018/national/mass-shootings-in-america/.

  6. Gilbert Davidson

  7. John Steinbeck

  8. MORNING BREAK

  9. INSERT TIMER HERE (45 MINS) LUNCH BREAK

  10. Major General McGuire

  11. James Hodge

  12. Understanding & Integrating AZ’s Model Code for Public Health Response Ethics James G. Hodge, Jr., JD, LLM Professor and Director

  13. PRIMARY OBJECTIVES • Explore role and implementation of crisis standards of care • Examine the need for ethical decisions in real-time emergencies • Assess the AZ Model Code of Public Health Response Ethics • Apply ethical principles in specific situations • Questions, thoughts, comments

  14. Five Regional Offices provide local and state support • Assistance online and by phone • Networkforphl.org The Network: Public Health Legal Support — National Scope with Local Expertise Western Region 16

  15. National initiative of the Robert Wood Johnson Foundation launched in 2010 to advance law as a tool to improve public health. • Leading areas include overdose prevention, health reform, health disparities, and emergency legal preparedness. • Provides strategic and targeted technical assistance, outreach and education to state/local under-resourced communities to improve knowledge, practice, or policies supporting health equity. • Collaborates with a broad set of partners across sectors to foster the use of the law to improve the health of communities. • Expands and enhances use of innovative, practical legal and policy solutions to improve health. About the Network 17

  16. Local, state, tribal and federal public health officials • Public health practitioners • Attorneys • Policymakers • Advocates Who Can Use the Network 18

  17. Networkforphl.org • Learn about the latest developments in public health law • Connect with others in the field • Share your public health law knowledge and experiences • Get help developing, implementing and enforcing public health laws • Access legal assistance, resources and training Join the Network 19

  18. Networkforphl.org • Resources, such as fact sheets, tables of state laws, legal briefs, and primers • Monthly webinar series • Public health lawyer directory • Library of legal assistance questions & answers • Conferences & other training opportunities • Network newsletters Online Resources 20

  19. Latest Resources Federal Public Health Emergencies Social Distancing Powers Liability of Health Care Workers and Entities Hospital Emergency Legal Preparedness State and Local Preparedness Emergency Declarations and Powers Mental and Behavioral Health Preparedness Emerging Threats Preparedness and Response Public Health Emergency Ethics Model Emergency Laws Crisis Standards of Care

  20. PRIMARY OBJECTIVES • Explore role and implementation of crisis standards of care • Examine the need for ethical decisions in real-time emergencies • Assess the AZ Model Code of Public Health Response Ethics • Apply ethical principles in specific situations • Questions, thoughts, comments

  21. Crisis Standards of Care “Crisis standards of care” apply during declared emergencies, allowing for legal and ethical adaptation to the changing circumstances and increased demands.

  22. Crisis Standard of Care Why is legal/ethical triage so essential? Because once an emergency is declared, the legal and ethical landscapes change.

  23. Emergency Declarations How the legal/ethical landscapes change depends on the type of emergency declared

  24. Emergency Declarations

  25. Levels of Emergency Declarations

  26. Public Health Emergency Defined - MSEHPA • Public health emergency: • An occurrence or imminent threat of an illness or health condition that (1) is believed to be caused by any of the following: • Natural disaster • Chemical attack or accidental release • Nuclear attack or accident; and • Bioterrorism • Appearance of a novel or previously controlled or eradicated infectious agent or biological toxin

  27. Public Health Emergency Defined - MSEHPA • (2) poses a high probability of any of the following harms occurring in a large number of the affected population: • Death • Serious or long-term disability • Widespread exposure to infectious or toxic agent posing significant risk of substantial future harm

  28. Public Health Emergency - Arizona “A state of emergency or state of war emergency declared by the governor in which there is an occurrence or imminent threat of an illness or health condition caused by bioterrorism, an epidemic or pandemic disease or a highly fatal infectious agent or biological toxin and that poses a substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability.” Ariz. Rev. Stat. § 36-787 (2006) 30

  29. Public Health Emergency Powers Government is vested with specific, expedited powers to facilitate emergency responses Individuals are given special protections and entitlements Emergency responders may be protected from civil liability Normal procedures and practices may be waived 18

  30. Legal/Ethical Triage in Practice Authority Liability Allocation of Resources Legal Triage Crisis Standard of Care Social Distancing Compulsory Powers

  31. Crisis Standards of Care Crisis Standards of Care Standard of Care Adapt standard of care to screen and treat increasing numbers of patients with limited resources The duty owed by health care practitioners to their patients depending on the circumstances

  32. CSC in Arizona

  33. PRIMARY OBJECTIVES • Explore role and implementation of crisis standards of care • Examine the need for ethical decisions in real-time emergencies • Assess the AZ Model Code of Public Health Response Ethics • Apply ethical principles in specific situations • Questions, thoughts, comments

  34. PHE Ethics • Decisions related to the allocation and use of scarce resources • Issues in providing health services consistent with CSC • Balance limitations on personal liberty to protect the public’s health • Choices and outcomes vary: • Across jurisdictions & political actors • Within public & private sectors • Among different emergency personnel

  35. Tough and Complex Questions in Real Time • Who is responsible for life and death decisions? • How do we allocate limited resources? • What information can we share with the public? • Who can be required to provide response efforts? • How do we protect volunteers from harm? • Can individuals be compelled to act? • What is the appropriate balance of communal and individual interests?

  36. Tough & Complex Decisions in Real-Time Vaccine

  37. Tough & Complex Decisions in Real-Time Ventilators

  38. Tough & Complex Decisions in Real-Time

  39. Tough & Complex Decisions in Real-Time

  40. Ethical Principles Bioethics Public Health Ethics Public Health Emergency Ethics

  41. PRIMARY OBJECTIVES • Explore role and implementation of crisis standards of care • Examine the need for ethical decisions in real-time emergencies • Assess the AZ Model Code of Public Health Response Ethics • Apply ethical principles in specific situations • Questions, thoughts, comments

  42. Arizona’s Model Code of PHE Ethics

  43. Model Code: Basics • Developed with input from ethicists, academics, practitioners, and others on generally applied principles • Meant for health care, public health & emergency preparedness officials/practitioners in public & private sectors • Plan/prepare/respond: declared state of emergency where health of the public is at risk • Implement CSC in appropriate circumstances • Supplements other ethical and professional codes

  44. Model Code: Core Principles

  45. 1. Duty to Care • Health care providers and practitioners have a duty to provide care during PHEs • Duty not to abandon • Duty to care despite risks • Duty to provide comfort care

  46. 2. Soundness • To the extent possible, responses in PHEs should be consistent with known or empirically-supported “best practices” • Effectiveness • Priority • Non-Diversion • Appropriateness • Risk Assessment • Flexibility

  47. 3. Fairness • In PHEs, similarly-situated individuals and groups should be treated in like ways • Consistency • Justice • Medical need and prognosis

  48. 4. Reciprocity • Those who face disproportionate burdens for the benefit of the community in PHEs should receive additional support • Protections for individuals • Protections for essential personnel • Protections for essential volunteers

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