Abstract

When a disaster or crisis occurs which involves medical personnel, it often necessitates a change in the standards under which patients are treated at a medical facility, as evidenced by the COVID-19 pandemic. These changes in standards of care can alter the healthcare worker's daily functions and their ability to provide the highest standard of care they are taught to provide. These changes in the level of care, called crisis standards of care, are often due to extrinsic factors such as resource availability, staffing, and the type of disaster or emergency that has occurred. Crisis standards of care are important part of the medical response that may drastically change healthcare during a disaster or crisis. However, often the medical and healthcare personnel are not consulted about how and when the standards of care are altered or how the standards of care can or will differ during a crisis, when or how that decision is made to transition to these alternative standards. This can lead to unintended consequences such as added stress or mental health issues for the health professionals who are having to treat the patients, knowing they can no longer offer the highest level of care, but continue to have the burden of the continued responsibility of patient wellness. While the H1N1 influenza pandemic in 2009-10 facilitated the opportunity to agree on crisis standards of care, the COVID-19 pandemic shone a bright light on the gaps and deficiencies in the agreed-upon standards and how these altered standards of patient care can affect those who have to use them. The psychological toll of working in an already stressful environment of having to treat an overwhelming number of the psychological toll of working in an already stressful environment of having to treat an overwhelming number of patients without a clear treatment strategy, the added burden of not being able to treat every patient with the highest level of care, adding in social distancing, which for some included staying away from family to keep them safe, was layered on top. The toll to healthcare workers included not only the mental health and stress aspects, but also resulted in "moral injury", a form of psychological distress from actions, or lack thereof, which infringe on a person's moral or ethical code which can lead to post-traumatic stress disorder. In this study, it was found that individuals who work in mental health or healthcare administration were not as familiar with the unique stressors faced by front-line healthcare workers when altered standards of care are implemented, including the decision to move to the different standards of care, how those standards of care should be implemented equally across the board to all patients, and most of all, the support needed for those doing so.