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HPP-Funded Crisis Standards of Care Exercise Prepared Nevada for COVID-19 Surge

March 2020​

Preparedness Activity:

In Spring 2019, the state public health preparedness program at the Nevada (NV) Division of Public and Behavioral Health (DPBH) used Hospital Preparedness Program (HPP) funding to host its first Crisis Standards of Care (CSC) exercise. This exercise brought together a diverse set of emergency management and health care partners to engage in open and honest discussion on CSC planning, including:

  • The Nevada Hospital Association,
  • ASPR Regional Emergency Coordinators (REC),
  • The Deputy Attorney General’s Office,
  • The Nevada State Epidemiologist,
  • The Nevada Tribal Emergency Coordinating Council, and
  • Representatives from the Nevada State Board of Nursing and Board of Pharmacy.
  • The exercise moderators, ASPR Regional Emergency Coordinators (REC), created discussion groups with individuals from across various disciplines and organizations, which was highly valuable in not only bringing multiple perspectives to the conversation but also creating relationships among these partners. For example, the leadership from Nevada State Board of Nursing brought critical insight into communication of CSC to general practitioners, whereas the Nevada Hospital Association served as an advisor for the state Operations Emergency Center and helped troubleshoot any resource shortages.

    As a result of the exercise, the State Disaster Medical Advisory Team (SDMAT) morphed into a primary group of consultants, identified through the Emergency Providers Organization of Nevada (EPON), that DPBH could call upon to consult with on CSC topics. EPON is a conduit through which DPBH can pool a list of pre-identified professionals across various specialties throughout the state. In this case, key individuals were selected from​ EPON for this core group of subject matter expert consultants. The SDMAT comes together at various times throughout the year to discuss and plan for various CSC interventions based on potential scenarios that may call for CSC.

    CSC Exerscise 1 CSC Exerscise 2 CSC Exerscise 3


    In March 2020, following the CSC exercise and several EPON consultations, NV updated its state-level CSC plan. This plan accounted for a wide variety of considerations, such as mental health and pediatrics, but it did not detail how to handle CSC during a pandemic. In early spring 2020, the NV Governor appointed a Medical Advisory Team to weigh in on medical considerations, including CSC. This team supported the SDMAT/EPON, including the State Chief Medical Officer, in developing a 134-page supplemental CSC document for COVID-19 with a variety of recommendations grounded in evidence-based practice and input from clinicians. The state has published five iterations of this document, with each version including more considerations and additional flexibility based on the continued COVID-19 response.

    An additional action item from the 2019 CSC exercise was to conduct a similar CSC workshop with each of the health care coalitions (HCC) throughout the state. The state scheduled workshops for each HCC and successfully carried out two of the four workshops before COVID-19 response activities ramped up.


    Nevada’s CSC exercise was instrumental in the COVID-19 pandemic response, as the partner relationships developed were key in building an inclusive, comprehensive set of CSC guidelines. This exercise also helped enhance recruitment for EPON, allowing for a wider pool of subject matter experts from a variety disciplines to help Nevada develop different aspects of the CSC plan.

    On April 1, 2020, the Nevada Governor released Emergency Directive 011 to implement CSC, and the plan has been implemented in all hospitals throughout the state at varying levels. CSC has provided much needed flexibility regarding health care in Nevada, allowing health care providers to do their best work and to do the greatest good for the greatest number of patients throughout the COVID-19 response.

    More Information: Please visit the Nevada CSC Plan website for an overview of the state’s CSC plan and for additional information on EPON. You can also find more details on NV’s health care guidance related to COVID-19 response on the Nevada Health Response: Health Care Facilities and Laboratories webpage.