Crisis Care Continuum Guidelines For San Diego County Hospitals

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What Is Crisis Care?

  • Anchored in best practices from across the country, and guided by ethical principles and a commitment to equity, Crisis Care plans ensure that, should conditions push a health care system into providing crisis care, it takes place in a coordinated and thoughtful manner, using a common framework, procedures, and decision making that best protects the health of all Californians.
  • The shift to delivering crisis care happens at the extreme, including potentially during a pandemic such as COVID-19. In normal times, customary routine services at General Acute Care Hospitals are provided through standard operating procedures. As resources become constrained, from facilities to supplies to staffing, systems shift from conventional care into contingency care.
  • Crisis Care falls at the far end of the spectrum, when resources are scarce and the focus shifts from providing the best care for the individual patient to delivering the best care for the patient population.

State Guidelines

  • On Dec. 28, 2020, the California Department of Public Health (CDPH) issued All Facilities Letter (AFL) 20-91 to General Acute Care Hospitals (GACH). This letter details updated California Crisis Care Continuum Guidelines and a Pre-Implementation Checklist.  On Jan. 6, 2021 the County of San Diego issued a California Health Alert Network advisory to local hospitals on Crisis Care plans.
  • Crisis Care plans are expected to addresses common categories of healthcare delivery, triage, staff and space that could arise when available resources are limited or insufficient to meet the medical needs of patients.
  • They should provide an overview of surge capacity and crisis care operational considerations for healthcare facilities with an emphasis on hospitals for the state of California.
  • The documents also are expected to provide information to support regional or county health entities, including health departments as well as individual health care facility operations. They do not alter or diminish healthcare facilities’ and systems’ responsibilities during catastrophic public health events.
  • Nor do they replace the judgment of the regional healthcare facilities’ operational management, medical directors, their legal advisors or clinical staff and consideration of other relevant variables and options during an event.

Health Care System Actions Expected

  • All County of San Diego General Acute Care Hospitals should:
    1) Review these CDPH guidelines 
    2) and continue to work with partners, including reaching out to the Medical Health Operational Area Coordinator (MHOAC) program via, for supplies and staffing requests to maintain contingent level of care as long as possible.
    3) As per AFL 20-91, General Acute Care Hospitals in San Diego County are responsible for three actions:
  • Posting their California Crisis Care Continuum Guidelines online.
  • Developing and sharing their communication plan with the County of San Diego Health & Human Services Agency through the Medical Health Operational Area Coordinator process.
  • Notifying the Medical Health Operational Area Coordinator when implementing crisis care standards by email and phone (619-285-6434).

In the event of a Crisis Care situation, hospitals are required by the state to serve as the lead in communicating to the public. The County will share on this web page information about hospital status to further assist with open and transparent communication.

Crisis Care Situations

  • None at this time. No systems have declared crisis care status.