From Flu Wiki 2

Forum: Are Hospitals Ready

15 August 2006

Leo7 – at 01:20

This is from a survey of 17 Chicago hospitals in the Daily Herald. It has some interesting findings such as 90% of hospitals surveyed had an Influenza Preparedness Coordinator-88% had created plans to prioritize workers and 56% tackled the tough eithical issues of resources allocations. I’m thinking either the Chicago experience is unique or hospitals have made plans that the employees are unaware of. Over all, there is still much needed work according to the article. My question and I invite any and all discussion is—Do hospitals plan to drag out THE PLAN only when we have H2H, and how effective will such plans be if the people who must work within them haven’t had a chance of input, evaluation and refinement? http://tinyurl.com/zbcec

Leo7 – at 01:27

There is much I didn’t mention but 67% has set a threshold for how many AF cases had to occur before activating emergency plans. Unfortunately they didn’t give the number. I haven’t been to work in four days, but when I took some time off there weren’t any written plans and no commitees either.

Ruth – at 07:26

I wonder if The Plan is actually their crisis plan that was created after 911. Bird Flu would be a crisis, so it’s the same plan.

anon_22 – at 07:43

I have a feeling that most of these plans are nothing more than pieces of paper filed away in drawers.

If you are trying to find out about your local hospital, don’t just ask whether they have plans or what is the plan, ask for details of their operational plans and the dates of their drills, either pending or completed. If completed, ask to see a copy of the report.

The Sarge – at 07:56

One of the key pieces of a plan is where they intend to put patients once they run out of regular beds. Some options, such as cancelling elective procedures, early discharge of some patients and greater use of out-patient services help. But, a lot of hospitals are looking at using long-term care facilities as alternate treatment sites. Fine, but have they actually inventoried the capacity of the facilities they have access too?

If a pandemic is bad enough, there is inevitably going to be slippage in the standards of care, e.g. nurse to patient ratios and triage of life-saving procedures. Many of these are subject to laws and regulations that will have to be relaxed or modified by government agencies.

Edna Mode – at 08:43

About a month ago I was at the dentist reading a regional magazine that had an article touting how well prepared our state’s hospitals are for pandemic or any event requiring surge capacity. The CEO of the largest hospital in our most populous city was going on and on about how well prepared her hospital is. The hospital’s surge capacity is 10 beds. I was sooo reassured.

The Sarge – at 09:12

Edna Mode:

Exactly! -

Even in a mild pandemic, there can be tens thousands of people above the norm who require hospitalization, many in ICU beds.

For a real eye-opener, go to the CDC fpandemic flu planning tools page and try out the Flu Surge tool, here . Plug in some numbers. Ten beds even in a small community ranks in the (not to put too fine a point on it) Fart in a Typhoon category.

ANON-YYZ – at 09:22

An HCW from Ontario posted a few months ago that nursing home residents will be sent ‘home’ to their relatives and the beds freed up for the pandemic. Call centers will be set up with nurses providing advice. Nurses will also travel to visit long-term-home-care patients. How to deal with gas station failure? I don’t know how all this will work out.

Grace RN – at 09:30

NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

Trust me when I tell you this. Check on your local hospital system(s).

Nursing homes discharging their patients? To whom? If the families couldn’t care for the patient prepandemic, what makes ANYONE think they’ll be willing/able to do it during a pandemic?

Nurses will also travel to visit long-term-home-care patients?

NO. I won’t be- there were nurses kidnapped in 1918 to care for people when the hospitals couldn’t! (If I go out for anything- no uniform or scrubs will be visable)

If it gets worked out, it will be done locally. Not county or state.

Grace RN – at 09:31

Sarge- “Fart in a Typhoon category.”

Love it! Will use it,too!

Average Concerned Mom – at 09:59

Seems like this might be the place for a lingering question I’ve had —

Last month in the Albany NY paper, there was an article about pandemic preparations. Here’s a quote from the section of the srticle dealing with hospitals and are they prepared….

“Elmendorf, the Albany Med epidemiologist, told contingency planners at their meeting that pandemic patients would take up 63 percent of hospital bed capacity, 125 percent of intensive care unit capacity, and 65 percent of hospital ventilator capacity.”

How big is an average hospital, i.e. it sounds like they are expecting to have to take care of about twice or three times the normal hospital case load. That would be bad all by iteslf, don’t get me wrong, I totally understand that already our hospitals are operating at peak levels, with little staffing.

But my prior understanding or a pandemic was, it would be more like 10 ro 20 times the normal caseload. Am I numbers challeneged somewhere? Feel free to ignore if this is a stupid question.

The Sarge – at 10:11

ACM -

It all depends on how bad the pandemic is, both from a numbers standpoint (attack rate in the population) and the severity of the clinical course. The above statement is a product of assumptions, based on numbers entered into the flu surge tools, no doubt.

10 or 20 times would be a rather extreme case, an outlier - less likely, but still possible. However, at those levels even the most rational mind shuts down - there is simply no imagining a way around the catastrophe. With numbers like were presented, one can imagine some strategy to manage the impact, using resources that could plausibly be brought to bear. IMHO, if you go much above those numbers, the mental process (and the system) breaks down, so there is no point in going there.

Grace RN – at 10:24

Not stupid! I’ll be honest- I don’t think anyone knows how many people will need acute hospital care and/or venilators. 10 times normal sounds quite possible. I can tell you this much- almost all hosptials have no bed surge capacity on a nice sunny non-panflu day. Mild flu seasons clog ER’s up in a bad way.

Add a MILD panflu to this and I will not be surprised to see a meltdown of America’s hospital systems. Expect this- after the first week of panflu in your area if someone is sick with panflu they will-at the very best- be sent to an alternate site for care. And that alternate care site may be miles away from where the patient and family live. What kind of care? If lucky- iv fluids or nasogastric/clysis fluids- think rehydration station. Big maybe- some iv antibiotics, ??? basic vents, but I very seiously doubt that.

Kirby – at 10:24

Hospitals in my area are NOT prepared. Neither are EMS, law enforcement and other agencies, particularly public health. I am directly involved in this with these agencies and I am the person in charge this area in my healthcare facility so I can tell you up front that it if happens in the coming months, better hope you aren’t in my neck of the woods.

Folks are dragging their feet and the Admins. don’t want to spend the money necessary to prepare. Buying a few gloves and masks is not enough to prepare for the masses. There has been adequate info given, sufficient supplies available to purchase at this time at reasonable prices and no reason to put off planning for what the ones in the know have been trying to tell us is likely to be coming. It doesn’t get much plainer than the Sec. of HHS going state to state handing out funds and saying, “Get ready.” When it is no longer safe to go to work, this RN will stay at home and will tell her staff to do the same. It will be suicide to remain at work in the environment we currently have unless major changes occur in our area.

K

Grace RN – at 10:26

Kirby – at 10:24

Thanks for telling it like it is!

What part of the world are you located?

cactus az – at 10:28
 This statement bothered me;

The saving grace, Gallagher noted, is that agencies such as the Centers for Disease Control and the World Health Organization are closely monitoring the spread of H5N1.

“We will know when the virus changes to become a pandemic. It’s not something where tomorrow it would be in the Northwest suburbs,” she said.

 Um….NO, not necessarily.

 I work in a small community hospital. It has 3 vents, and a couple of old IPPD machines. The chances of remaining operational in a pandemic is nil. On many shifts 25–50 % of working staff are registry. Will they drive up there in a crisis? No…. I am registry, I will be staying home, and I bet the others will do the same.
The Sarge – at 10:28

A thoughtful paper appearing in the EID regarding “Duty of care”:

Virulent Epidemics and Scope of Healthcare Workers’ Duty of Care

Tom DVM – at 10:35

Grace and Kirby I take my hat off to both of you. It must be difficult knowing what you know in these institutions but have no control or say in changing things for the better.

Grace. The requirements for broad spectrum antibiotics, oral electrolytes, anti-fever medications and prednisolone are going to spike by 10 times…a hundred times…a thousand times…or a hundred thousand times.

If the production time ramp up exceeds the speed that the wave of H5N1 overtakes it…there is a very good possiblility that not only will there be no healthcare facilities (given in my mind) but there will be no medicines avaliable to nurses to give to the sick for a significant period of time and possibly for the duration given that 50% of pharmaceutical workers will also be out.

ANON-YYZ – at 11:00

Grace RN – at 09:30

See page 4 of PDF: Ontario Pandemic Plan - Planning Goals, Approaches and Assumptions

http://tinyurl.com/kdxyy

“Hospital capacity is already limited and could be further reduced because of staff illness. Inter-hospital assistance will be limited because of a rapid spread of influenza. ‘’‘Home care and long-term care homes will provide surge capacity by providing influenza care’‘’ that will help avoid hospital admissions and allow early hospital discharges.”

The Sarge – at 11:05

Yeah. Sure. That’s the ticket! Yeah!

Tom DVM – at 11:10

Sarge.

They (we) in Canada having a heard time admitting

…’WE’RE SCREWED’.

Np1 – at 11:12

Our 66 bed hospital has surge capacity of 30 beds. We have decided once we reach that, and that includes 82 “ contaminated” beds in a sealed off area, it becomes a county problem. We will close our doors and we have security to enforce it. We have enough food, fuel for our generators and oxygen to last a week with no resupply in a 1918 type of event. Is this realistic? Depends on the assumption used. It is the best we can do at this time and we have a detailed plan which we started educating staff on in July. Complete roll out and actually handing copies of the plan out will be in September.

Sometimes I look at those more pessimistic assumptions and dispair. When the generators are running low and the food is running out what will we do with the sickest patients? I do not want to go there. We would do better to not start treatment, but as long as we have personell and supplies we will try. The calvary that comes to rescue us will be the one with four horses. Kelly

Tom DVM – at 11:12

The big picture is that despite the obvious defficiences, we forgot about SARS as soon as it was over…we have learned nothing and my fellow citizens are about to find out that we are going to be in the same position or worse than we were in 2003…

…it is going to be a rude awakening!!

ANON-YYZ – at 11:21

Grace RN – at 09:30

Read P.51 of PDF very carefully between the lines: A Guide to Influenza Pandemic Preparedness and Response in Long-Term Care Homes (Ontario, Canada)

http://tinyurl.com/mj8lt

15.2 Has the LTCH made arrangements with other LTCHs and other services to relocate residents if the LTCH is unable to meet residents’ needs (e.g., transfers between hospitals and Long-Term Care Homes, local LTCH partnering to support each other by delegating certain resident care activities to one organization while the other focuses on the care of ILI/FI residents )?

LTCH = Long Term Care Home

ILI = Influenza Like Illnesses

The Sarge – at 11:30

Np1 at 11:12 -

“Sometimes I look at those more pessimistic assumptions and dispair.”

Exactly - there is no sense in trying to plan for what you will do in a situation that you know already you have no resources to cope with. Better to focus on what you CAN do.

Science Teacher – at 11:33

I think that if the pandemic is a bad one, we will be looking at hospitals breaking down quickly and closing doors within days. There is no way that any hospital will have staff or supplies for this type of dire situation. In my area I read in the paper some time ago that state officials were looking for large buildings to use for overflow patients. IMO these will become amplification points with few resources to help the sick. Hospitals that offer assurance that their plans will work in a pandemic situation may be offering false security. Be very skeptical.

ANON-YYZ – at 11:41

Science Teacher – at 11:33

Perhaps why there’s a plan to evaucate residents of Long Term Care Homes - saving what could be saved. I hate the thought, they are going to use the LTCH as temporary morgues…

It took 50 days for the patient in Shenzhen, China to recover, with probably the best resources: Tamiflu, isolation, ventilator etc . This will be a luxury that no country can afford.

Np1 – at 11:50

The Sarge – at 11:30: That is why we have moved ahead with the plan that we have. I also have used the oppourtunity to educate staff, advising them to stock up at home. I am advising those with children at home may want to consiter not coming anywhere near our hospital. But you cannot stay at home, even if you do not come to work, if you do not have food, water,ect. I could go home and stay on my 40 acers for an easy 6 months and not lack for anything, but I know I am an outlier. The truth is , and every person working on our plan knows this, anything like a 1957 pandemic will shut us down. Kelly

Leo7 – at 11:53

Hi everyone-great discussion.

NP1-Your facility is well above the curve. You’ve got a plan and you know your limits, but more importantly you’ve begun educating the staff. When the staff gets facility education then they will make home planning. So you’re a gold star facility to me.

With the recent survivors taking >50 days for discharge, I believe creates a seperate situation. Once a flu bed is filled it might take a long time for it to clear. The fake reassurances that the recovered will help take care of the still ill won’t happen.

Did anyone notice that the article also addressed the uninsured? Staff need to be paid, but will hospitals be allowed to turn the non-insurred away? Usually there is one main charity hospital the others do a little until state monies run out.

I have no answers about where the hospital staff will eat and sleep. The only thing that makes sense unless there is a motel across the street is to maintain the norm. Sleep at home and drive to work. My facility has no empty floors, to set aside for sleep, unless they intend to limit beds.

The first hospital to activate the AF emergency plan will be closely watched by the others. If there is panic it will create a domino effect across many states. I hope hospitals with plans start advertising them now—before it hits-otherwise expect chaos.

Np1 – at 11:55

Oh and speaking of “ alternate sites” as mentioned in the federal plan( and most state plans ): we dropped any ideas of doing this because we will not have staff or supplies! What the hell as those people smoking? Kelly

Np1 – at 12:02

Leo7 – at 11:53: we have purchaced air mattresses, enough for maybe 1/3 to 1/2 of the staff and are planning “hot bunking” it’s a swab thing and I don’t like it but it a money limitation. We also have purchased a pallet load of kitty litter to use in portipotties. If sewage lift stations fail we can cut the sewer line and drain into a basin near the hospital. We have our own well well so as long as our generators hold out we shoild be able to flush! Kelly

cactus az – at 12:05
 If they come to the ER the non insured are a non issue. They have to be treated per Fed regulations.
The Sarge – at 12:06

Np1 and Leo7

One possibly overlooked physical resource for overflow is schools - they won’t be open in a pandemic, there’s facilities, kitchens, heat and light. The trouble is how do we staff them?

Np1 – at 12:09

cactus az – at 12:05 What hospital are you at? If you are comfortable saying. I am in Showlow at Navapache Regional Medical Center. Kelly

Leo7 – at 12:11

NP1:

Yes, and exactly if you triage to an alternate site, how do they get there? I wonder if well family members will even stay in the triage line with their relative. I hope so…but it may go the other way. Those forty acres will be looking mighty good one week into a full surge scenario. My one acre will seem like heaven.

Sarge 10:28 That is a good article and it addressed patient abandoment in a sane way. I hope we don’t see this issue come up. But if there is no food delivery and even if we still have electricty and water—the staff will not be able to keep working. Taking care of patients is hard work, and if families do stay with patients there will be extra mouths to feed. When the medication runs out, PPE, and medical supplies—what will we do?

LR – at 12:17

While nobody can truly be ready for a pandemic, I know of a lot of planning going on in Michigan. Hospitals, first responders, public health, and many others, are working together to form AND TEST pandemic plans. In many areas, hospitals are planning on running Alternate Care Centers which can provide IV fluids, pain medicine, and other basic care. They can be staffed by ONE physician and a couple nurses and their purpose is to ease the load on the hospitals. I am sure that most states are doing this as well, because the Pandemic Preparedness funding requires it.

I also know of both hospitals and coalitions, like the one described above, that are purchasing gloves, masks and yes, even ventilators.

So, No, we are not ready (I contend that it is impossible) but Yes, people and organizations are working to mitigate the impact of a pandemic.

cactus az – at 12:17
 Np1
  I`m registry, have been at Payson a lot the past few months.
Leo7 – at 12:18

NP1_Wow! I can say with absolute candor…the flush factor is right after food and water. Your plan is detailed and I know from prior posts you and your facility worked on it a long time. I’m taking notes and if such committee materalizes at my work I will mention the air mattressess—good idea. I can hear some of my co-workers with back injuries whining they better be those elevated air mattressess. You will work twelve hour shifts-did you plan for time off?

Np1 – at 12:26

Leo 7: Amount of work time depends to some extent on work to do and amount of staff. We will ask for 72–96 hour committments in our sealed comaminated unit. All staff working in there will have temp taken BID. Then staff can go home and are encouraged to self isolate for at least 72 hours, monitoring temp. We will have a “ clean “ area in surgery preop and pacu, about 20–24 beds. We will try to keep those staff close by bunking them in another building on campus. Kelly

Little Kahuna – at 12:28

In our county, there are 378 licensed hospital beds available. We have the staff to fill approx. 350 of those beds. However, if the flu affects 30% of the population, then it will also affect 30% of the health care workers. So, in reality, we will only have staff to fill approx 245 beds.

We need, according to 1918 pandemic figures, 2,860 beds county wide. The red cross is placing 1,600 folding cots in schools across the county. The national gard has 800 beds available in 2 camps. The Boy Scouts of America has approx. 200 folding cots and might provide more from a couple camp sites in the valley.

The biggest issue is trained personnel to assist. So, we are looking at retired doctors, stay at home licensed nurses, pharmacists, dentists, EMT’s, Red Cross, Paramedics, national guard personnel, epidemiologists, etc. (anyone trained, certified, licensed) who we can coordinate with in small teams. We’ve contacted all churches in the area for assistance in finding trained volunteers.

The challenges are many, but the biggest is that people are stuck mentally in the 4 phases of denial: 1) They don’t believe it will happen 2) If it does happen it won’t affect me 3) If it does happen, there is nothing I can do about it 4) I knew it all the time, but it is too overwhelming to even think about.

Little Kahuna – at 12:29

In our county, there are 378 licensed hospital beds available. We have the staff to fill approx. 350 of those beds. However, if the flu affects 30% of the population, then it will also affect 30% of the health care workers. So, in reality, we will only have staff to fill approx 245 beds.

We need, according to 1918 pandemic figures, 2,860 beds county wide. The red cross is placing 1,600 folding cots in schools across the county. The national gard has 800 beds available in 2 camps. The Boy Scouts of America has approx. 200 folding cots and might provide more from a couple camp sites in the valley.

The biggest issue is trained personnel to assist. So, we are looking at retired doctors, stay at home licensed nurses, pharmacists, dentists, EMT’s, Red Cross, Paramedics, national guard personnel, epidemiologists, etc. (anyone trained, certified, licensed) who we can coordinate with in small teams. We’ve contacted all churches in the area for assistance in finding trained volunteers.

The challenges are many, but the biggest is that people are stuck mentally in the 4 phases of denial: 1) They don’t believe it will happen 2) If it does happen it won’t affect me 3) If it does happen, there is nothing I can do about it 4) I knew it all the time, but it is too overwhelming to even think about.

Leo7 – at 12:30

LR:

Please share who will staff the alternate centers? If hospitals reach full capacity, and assuming some staff won’t come in ie single parents of children, pregnant, how does that work? Second teaching hospitals may do better than most because of layers of attending doctors, residents, medical students and students from every resource. But how do you get private doctors or nurses who work for private doctors in offices next to or on hospital property, but not on hospital payroll or under hospital policy and procdure, to man alternative sites or over stressed hospitals for that matter? I think these people will make their own plans seperate from a hospital, don’t you?

cactus az – at 12:37

LK

 And, have you stocked enough PPEs for these volunteers? And, enough IV fluids,angios, start kits, tubing,meds for these 2,600+ patients?

 I bet not, and I also bet that no small hospital has anywhere near enough supplies. And will not/cannot get them.
The Sarge – at 12:39

In a pinch, we can can get by with minor changes in some standards of care, like a boost in nurse-patient ratios. Bringing in retired or non-traditional HCW’s sounds good, but are your jurisdictions talking about changes in scope of practice, license reciprocity? How you plan on covering them for malpractice and liability?

What about the big decisions - i.e. who do we put on or take off vents? How do we handle reverse triage (instead of who do we treat first, who do we let die first)? Have you engaged a medical ethics panel, your state health, education and licensing agencies?

Leo7 – at 12:42

Folks—I’ve got to check out for awhile, but keep posts coming. I’m hoping if people browse this site after yesterday’s news and read this thread, they might be interested enough to make local inquiries. Public opinion is important to healthcare which is why they advertise on TV and radio.

The Sarge – at 12:47

See ya! Hurry back!

LR – at 12:47

Leo7:

There has been a lot of discussion about the staffing, but the bottom line is that moving one hospital doc to the ACC ccould keep ?50 patients out of the ER. I think most would agree that it would be well worth it. You are right that it would be much more difficult to use a private doc for the ACC.

ANON-YYZ – at 12:51

The Sarge – at 12:39

Very good questions. And thank you for working so hard on issues that will affect us directly.

This thread gives me hope that some improvements will come out of the discussions.

Np1 – at 12:58

We address altered standards of care in our plan, with reference to state statutes that addressed those issues. In Arizona we can, in an emergency, use anyone from anywhere with their licence from whereever! Utilization of equipement is more difficult. The practitioner in the sealed unit, probility one of our hospitalists, would have to make that decision in house.The sealed unit includes ICU and our medical and surgical units. For ER the doc on duty would have to make the call. Bioethics is struggling with it, but how that advise will play out in the real world is anybodys guess.

Triage to help the most saveable is a sticky issue. Our ER docs are trained to admit the sickest, period. When they have put the last vent on a 70y/o with multible comorbities what will they say to the mother of that 7y/o with the flu that needs a vent? Will they just keep admitting and pass off the issue to the hospitalists? And who will win the world cup next year? Hell, I don’t know.Kelly

The Sarge – at 13:04

ANON-YYZ -

I am rather pleased with how this thread is going, if I may say so. Lots of good perspective being shared.

Questions are easy - its the answers that come hard and; sometimes the realization that there are no answers, like when projections exceed conceivably available resources. We can and should, however, stake out the middle ground, where we can apply creativity, clear away bureaucratic quibbles and care for and save those who can be saved.

And let us hope that it does not come to pass thus: Exodus 11

5 And all the firstborn in the land of Egypt shall die, from the first born of Pharaoh that sitteth upon his throne, even unto the firstborn of the maidservant that is behind the mill; and all the firstborn of beasts.

 6 And there shall be a great cry throughout all the land of Egypt, such as there was none like it, nor shall be like it any more.
cactus az – at 13:05
 Np1,

 Did you read the article on the news thread from Mohave County? Sounds like they are actively working on a plan.

 At least they will have lots of empty beds across the river if they want to start a ACC center.

 And…drum roll,please….they are telling their folks to start stocking 3 months worth of supplies.
The Sarge – at 13:07

Np1 -

Dittos to what Leo7 said - you seem to have a firm grasp on the details and a good plan in the works. Light years ahead of many, if not most IMHO.

Good job!

OnAndAnonat 13:08

Little Kahuna-

FYI-

National direction is that Red Cross WILL NOT PARTICIPATE in patient care, opening or setting up patient shelters or any other activity than mass feeding. Red Cross will do feeding, that’s it.

ANON-YYZ – at 13:09

The Sarge – at 13:04

“We can and should, however, stake out the middle ground, where we can apply creativity, clear away bureaucratic quibbles and care for and save those who can be saved. “

And one day one of these creative ideas will save a life.

LMWatBullRunat 13:13

IMHO, if there is a severe pandemic, the best course is to STAY HOME. If I could send one message, it would be-

“While we deeply regret this, the reality is that we can do NOTHING for you during a severe pandemic. STAY HOME if you get the flu during a pandemic.” That is what I have told those close to me.

Np1 – at 13:16

cactus az – at 13:05″ I saw it but I do not have much faith that most people will do it. In California, where earthquakes are a way of living, and in the Gulf coast, with most recent bad JuJu, people are still not prepared. Well, better to save a few than none, I think. Kelly

Grace RN – at 13:33

ANON-YYZ – at 11:21

Yeah, I know…(re: LTCF becoming de facto acute care centers…)

Has anyone there run a tabletop exercise that involves calling their patients families to “come and get them now?”

It’s a joke- the exceptionally poorly paid nurses aides who do the bulk of the work in nursing homes may not show up.

Some facilities who plan in detail way ahead of time may do better. The bulk of them-including where I am working now- nadda.

Re: “patient abandoment”

Yes- HCW’s have a moral obligation to care for patients with infectiousw diseases. The facility that they work in also has the first and higher moral obligation to have adequate supplies and planning to offer them some degree of safety.

If they fail to do so- all bets are off folks.

nsthesia – at 13:57

Little Kahuna:

Your post comes down to the least common denominator in all of this - staff. As all of us that have worked in hospitals for any amount of time knows…it isn’t the number of BEDs that a hospital/facility has, it is the number of STAFF available.

I can not tell you the number of times working in an administrative role (I’d rather do a cardiac anesthetic on a 500 pound diabetic patient with renal failure, HIV+, bilateral above knee amputations AND a Jehovah’s Witness than ever do admin again…BTW, this comment is to let you know just how DIFFICULT it is to do a good job in these roles…not to disparage anyone with any of the aforementioned) I had to tell the ED we had to divert ambulances because of lack of staff. That’s when I decided clinical complexities were much more fun and went back to school for another decade.

People go to hospitals for CARE, not to just lie in a bed. You do that in a hotel. Ya gotta have (qualified) staff to fill those beds (ethically). We have problems staffing hospitals today, sans pandemic. All the retired providers in the US wouldn’t fill the holes in the dike. A lot of them retired because of the stress of the job. There are even programs today to recruit disabled providers(!) because we are so understaffed.

In 1918, they took all of the students in medical, nursing, tech programs and brought them into the hospitals. That is a scary thought, but it would at least be somewhat useful.

In many of the facilities I now cover, most of the staff (60%) is part time (PRN). They are less expensive to hire because they get no benefits and, often, no guaranteed hours. These people will not come in during a panflu - they are not “real” employees. Some of the facilities DO have pandemic policies, but the only supplies currently stocked is a MINIMAL supply of N-95 masks and gloves.

An extra 100 patients/day would swamp a 500 bed hospital in one day. And as someone mentioned, these patients are NOT leaving in a day or two (unless they die). In some of the reports in the 1918 panflu, at the military bases, on day one, 2 patients showed up, day 2 - 30, day 3 - 100, day 4 - 300, day 5 - 1000. The growth was exponential, and that was in a population of approx. 50,000. My city could not handle a 1000 patient excess in our hospitals.

ACM, your article states “Elmendorf, the Albany Med epidemiologist, told contingency planners at their meeting that pandemic patients would take up 63 percent of hospital bed capacity, 125 percent of intensive care unit capacity, and 65 percent of hospital ventilator capacity.” 63% of bed capacity for panflu patients? Does this mean the hospitals are not near capacity now? I could not even conceive how these numbers could be credible. I’ll believe those numbers the FIRST time I ever see an epidemiologist work OR staff a hospital.

Here’s MY guesstimates: panflu patients will take up 200% hospital bed capacity, 150% intensive care capacity and 95% of hospital ventilator capacity. The patient to staff ratio on the floors will be 10:1 and 4:1 in the units. UNLESS this virus wimps out and turns into a human version of kennel cough.

I have no doubt that we will find BEDS/cots for many patients. But we will have a h*ll of a time finding staff to care for the patients lying in them.

Texas Rose – at 14:04

We get the Research channel and they frequently show programs dealing with a potential BF pandemic. This is one dealing with pandemic preparedness for health care facilities:

http://www.researchchannel.org/prog/displayevent.asp?rid=3206

This particular program has an emphasis on the Seattle/King County area but the general discussion of problems facing health care facilities gives a good idea of the problems all HCF are facing as they prepare.

Grace RN – at 14:36

nsthesia – at 13:57

“I have no doubt that we will find BEDS/cots for many patients. But we will have a h*ll of a time finding staff to care for the patients lying in them.”

Quite true. Not to mention-sheets, blankets towels, bedpans, food, water, soap, tyelnol, iv fluids…….

The Sarge – at 14:41

But as professionals, ‘in the business’ so to speak, do we not have an obligation to try and address these shortcomings? Sure, we can easily imagine the Old Testament/Stephen King scenario where all systems fail and throw in the towel at that point. However, the reality is likely to be something less than that - the middle ground I mentioned before. Np1 sounds like they have a plan that is on track, but that is not the case in many or most facilities.

If nothing else, we can be gadflies that afflict the too-comfortable and complacent hospital admins, government officials and the public in general to take heed of the warnings and do whatever is practicable to prepare.

The Sarge – at 14:55

At sea, the last resort when all systems fail and you’re in a storm, you hunker down and lie a-hull. That means giving up all efforts at control and letting the boat take whatever attitude it will toward the wind and waves. Sometimes the boat does fine - plenty of people have abandoned ship only to have their boat turn up intact hundreds or thousands of miles away. Sometimes it sinks with all hands…

However, that’s not what the prudent mariner plans for. What is the percentage of boats that catch fire or sink at sea? My guess is its pretty small. Yet we equip ourselves with all manner of expensive gear, life rafts, firefighting equipment, sea anchors, life vests, exposure suits, EPIRBs… None of which we ever want to have to use. Yet we have it and pay beaucoup bucks to maintain it, because the risk is there.

We could say, “If I get hit with a 100 foot rougue wave, or get caught in a category 5 hurricane, none of it will do me any good, so why bother?” I could also say (and some few do, unfortunately) “The risk is one in a thousand - it won’t be me.” The wise course though is somewhere in between, and that’s what we plan for. The analogy works for panflu too. IMHO.

Grace RN – at 15:37

Sarge-re”But as professionals, ‘in the business’ so to speak, do we not have an obligation to try and address these shortcomings?”

Of course we do. But what do we do when TPTB (once again) refuse to listen to us? We are not in upper management. And we are talking about non-cost effective planning measures. IMHO, healthcare decision making is as much ‘JIT’ as ordering widgets.

There is a finite amount of time to be of a JIT mentality.

The Sarge – at 15:55

Bad publicity is an economic factor too - and a facility that hasn’t been progressing toward a workable flu plan ought to get some. TPTB can ignore any one of us. However, when enough people - or maybe more importantly, the right influential people - are howling, they can’t ignore the din anymore. We go back to the older thread on “Influencing the Influencers.”

Yes, the JIT formula is at work in the health care industry, just like any other. You can’t compete economically if you don’t embrace it, in normal times. However, JIT is also brittle and failure-prone, IMHO, when multiple systems or critical pathways are impacted, be it from ice storms, blackouts, labor disputes or panflu.

I go back to my point about safety systems - we put sprinklers in high-rises, smoke alarms in our hotel rooms and life boats on our ships. None of these contribute anything to the bottom line, in normal times, yet we do it because experience has shown that bad things happen in the AFTERMATH of disasters to people who ignore prudent warnings of risk. Things like lawsuits and prosecutions and stockholder revolts.

Maybe though the way to go forward is political - come to think of it most of what I mentioned came from the political fallout, in the form of laws and regulations. It took something like the Triangle Shirt Company fire to get most of the fire safety laws on the books, and the Titanic for life boats. Become a PIA to your local legislators.

nsthesia – at 16:02

Sarge,

Absolutely. Do not confuse reporting the current shortfalls in resources with “giving up.” I, personally, do NOT give up easily. Ask anyone who has ever told me, “It can’t be done.” They better get out of my way.

Our healthcare system has some significant problems. Pretending we do not is IMO, more dangerous than capitulating to an unknown panflu situation. I don’t think many HCWs would do that anyway. We tend to have volunteerism entwined in our DNA. I think most of us take that as a fundamental part of our makeup. So…we start from there and go upwards.

BUT, we also know the good, bad and the ugly. Not many NON-HCWs know that part of the system, cuz politically, it is NOT in your best interest to comment on it publically. And…ya gotta BE in the system to know the deficits. Do not believe whatever you read on paper, talk to the staff.

Accepting that we HCWs “WANT TO FIX THIS PROBLEM” is a given. We are also realistic to a fault and know what the potential is. Many of us have been in too many clinical situations where the outcome was inevitable death, only to continue resuscitative efforts for hours, expending every resource to an inevitable loss. And we do it over and over again…just because it is done that way and we do not like to lose.

If we are faced with a panflu of a 1918 lethality, our system WILL be overwhelmed. I will be the first to try and tackle whatever comes in the door. I will be the one organizing, teaching, irritating TPTB to get motivated and take this threat seriously. I speak of this situation almost on a daily basis to see who is listening and what people know.

But, we operate on a short list of inventory items. We operate with part time staff. Our staff age hovers around 50 and many of the staff have medical problems themselves. Our politicians, admins and public have turned “soft and emotive” and don’t want to make waves.

There are some hard facts to face if a panflu erupts. I am not sure most want to face them. Stating the problems and insisting they be addressed is NOT GIVING UP. The first step in any problem is to ADMIT YOU HAVE ONE.

But, these issues must be addressed and resolved. It is one thing to brainstorm. But I learned years ago, that in most HC facilities, that the PROCESS is the end result. Few problems were resolved because of turf battles and personality conflicts. Typical bureaucracies.

THIS situation could be a deal-breaker. Your analogy of a ship with it’s emergency gear is useful. Now imagine that same ship with beautiful teak decks, polished brass accents, few life rafts, decks that are isolated from one another, poor communication, dangerous seas and a belief that it is “unsinkable”. Oh yeah, I think we already HAD that scenario. IT SANK. The problem, is that our healthcare ship is NOT being stocked. Only the captain and officers will get a lifeboat.

Our healthcare system has paternalistic origins. Patients are told what is good for them, the staff (majority female) is told what is good for them. It is often a unilateral communication system. THAT is the problem. Listen to those doing the care. THEY can help solve these problems. Today’s and tomorrow’s. Business studies have shown that giving ownership to those at the point of work is a cost effective, efficient method of solving problems.

Use the thousand brains in a facility, not just a few dozen, to problem solve. But, it ain’t gonna happen. THAT’s why I worry. And that’s why I plan to work my tail off until I see that no one listened and that there are no resources. Being the stepmother of 4 kids that have lost both parents, I take my role seriously. I am NOT subjecting myself, nor them, to a futile endeavor, and MORE unnecessary loss.

Let’s hear realistic solutions. Let’s hear how it is going to be financed. Let’s hear who will be present and accountable. Let’s see a timeline.

And let’s pray we have time to implement changes. System change takes years. This virus may make a fatal change today. Giving up is NOT part of the plan. But, IMO, we need a new paradigm to bring to this fight. What does it take for people to see that when a novel attack by an enemy is implemented, that it takes a novel response?

Sarge, I DO know that if I had my say, I’d vote for YOU to be on my planning committee. Nothing like an alpha male with a big vocabulary to get and keep one’s attention. ;)

Grace RN – at 16:08

nsthesia – at 16:02

I wish I were as optomistic as you-TPTB in 1918 don’t look or act much different than now. the feds have told the states using little tiny words to get ready, yet the trickle down factor absorbed much of that.

Making headway locally for me isn’t much better. We do need a new paradigm. But after the 1918 panflu the “Great Forgetting” started.

The great forgetting/not caring about the first panflu of the 21st century has already started. Why?

The bottom line- and it’s always green. And look at who controls the pursestrings.

nsthesia – at 16:16

Wow,

Sorry for the long post, y’all. The adrenaline was flowing.

Sarge, just like the FAA regs are “written in blood”, nothing gets done in healthcare until the risk/benefit ratio = being worthwhile to expend money. That means, unless we see an UNacceptable number of potential deaths on the horizon (or on our doorstep), not much will be done. UNLESS the expenditure could be reclaimed somehow.

The bottom line is the bottom line. The hard truth is that altho HC deals with lives, it is still a business in our country. Probably even in socialized med countries. Most developed countries everywhere are having problems dealing with aging populations and paying for their healthcare.

This is a significant factor in preparedness planning.

And if most of the general population does not currently worry about a panflu, why would they have negative feelings toward an institution that is not preparing? Catch-22.

Ya know how that levee break in New Orleans exposed some ugly problems? Methinks a panflu would be the healthcare industry’s levee break. Many of us have been sticking our fingers in the dike for years. No one listens.

Np1 – at 16:20

Our pandemic plan calls for administration to be layered “4 persons deep” to make sure that we have someone in charge even with high morbitity and mortality rates. We were discussing this the other day and our IC RN had been in contact with the county Bioterror/EMS people. She laughed and said they barely had one person to cover critical administrative areas! We are in better shape than them in many ways. Our plan also calls for one of these administrators to be in the sealed “flu care “ area at all times fror critical decisions. This plan should go to the administrative team later this month. They must ok it to go out to staff. Except of course I have already started leaking it. They have mostly ignored the issue. This plan is strong stuff, and we will just see how they react. Kelly

ANON-YYZ – at 16:24

nsthesia – at 16:02

Bravo!


nsthesia – at 16:16

just like the FAA regs are “written in blood”, nothing gets done in healthcare until the risk/benefit ratio = being worthwhile to expend money.

Just look at all the Bill Gates, former President Bill Clinton, celebrities like Richard Gere all attending the Aids ‘Pandemic’ Conference in Toronto, promising big bucks … 20 years after the opportunity to prevent it has passed.

Written in blood indeed.

The Sarge – at 16:27

nsthesia -

I am humbled and flattered. I AM out there kicking shins in a number of places. Sounds like you are too. The fighting spirit really comes through. And maybe just a little rage ;) Rage is good and productive sometimes, but mainly when applied IN ADVANCE OF NEED. Everyone will rage after the dust settles: fling invectives, file lawsuits, make lawyers rich and craven politicians famous. But what good does that do for the victims? We need to mobilize here and now.

I recently watched again “Tora! Tora! Tora!” - a rather excellent war movie IMHO about the Japanese attack on Pearl Harbor. I am struck by the number of warnings that were ignored, mishandled or were delayed in transmission. If you have seen it, think of yourself as the operator of the radar station (a new and not entirely trusted technology at the time) who was trying to report the contact with the inbound Imperial Navy bombers. That and a dozen other indicators were not timely relayed to the commanding officer Admiral Kimmel by his underlings. (in the movie that is - not sure if its a historical fact). It was an unprecedented and, as you say, novel attack that in retrospect seemed easy to predict. I feel like we are in an analogous situation now. Sure, we can court-martial today’s Admiral Kimmels after the fact, but little good it does in the present. Other examples abound, including one bright day in September, 2001.

Whenever will we learn?

Tom DVM – at 16:33

Sarge. Exactly!! I couldn’t agree more with your second paragraph at 16:27. The signs are there and have been there for nine years.

nsthesia – at 16:42

Those that do not learn from history are doomed to repeat it…

Perhaps that is how a pandemic really kills. A novel virus emerges. And not only is no one immune, no one can remember the horrors of the last one. It becomes just a “story” with no feeling of reality or pertinence to today.

The Sarge – at 16:48

Shhhh! The mods are sleeping…

Melanie – at 16:51

No, they aren’t.

Kirby – at 16:56

Had to leave for a while and appreciate the posts above.

I, too, work in rural health care. I am the Infection Control Professional.

We are mostly geared toward outpatient services but have 25 inpatient beds and designated as Critical Access. However; we also own a wellness center and two large home care agencies so additional staff is available to our hospital staff.

Our hospital plan has been drafted and includes out of hospital triage of patients so that flu patients can hopefully be segregated from non-flu patients. We have a large adjacent wellness/rehab center that would be used as a clinic next door to the main hospital and beds can be moved into it, meals transported from the main hospital, etc. Supplies, meds, IVFs, etc, would be readily available from the main hospital as long as space is available at this site. Ventilators are a problem. We only have access to about 10 total, including those from our respiratory home care agency.

We use Family Medicine residents in our ED at night and on weekends so they will be used to help staff our out of hospital clinics. As we outgrow our wellness center, we will use civic centers, and church social halls working from the facility outward throughout the county. These sites will be used for supportive care only. We foresee large numbers of patients per MD/RN and more support staff assigned to clinics than licensed staff.

We do not have stockpiles of medications, IVFs, etc. We do have kits made up (400 thus far)which consist of 1 impervious gown, 4 pairs of gloves, 3 N95 masks, 1 head cover and 1 pair shoe covers in gallon ziplock bags. 50 ziplock bags are already packed into duffle bags that can be sent to off-site clinics for use by staff to be donned prior to entering clinics and the extra gloves/masks replaced in the bags for use when changes needed as the shift goes on. Due to everyone having the same illness, changing of gowns, shoe and head covers during the shift will not be as frequent as gloves/masks. There will be other limited supplies of each available but each person will receive their own supply in a bag at the beginning of the shift to ensure each has at least some changes available in case supplies run low or give out.

We have discussed purchasing Tamiflu to have on hand for prophylactic treatment of any staff but this has not been done.

Security will be a problem as law enforcement is limited already and the hospital uses off duty officers for security regularly. During pandemic, all officers will be needed for regular duty and no hospital security will be available. There is no plan for this and Admin. has not considered the implications of it. Same with EMS services. Use of EMS personnel as clinic personnel has not been considered as they, too, are limited and believe that they will be stretched thin in transporting patients to ??where???

We have one large empty grocery store building that still has power on and large refrigerated cases, and freezers in place that can be used for storing of bodies but space is limited. Four local funeral parlors can only accommodate 4 embalmed bodies each. The hospital has no refrigerated morgue. There are three empty industrial plants that can hold hundreds of bodies unrefrigerated?? Or can also be used as clinics but no bed availability. We have total of 25 cots that will be used in wellness building in initial phase and only donated blankets on floors of clinics thereafter.

Only one local nursing home and two local boarding home, both at capacity. No plans to send patients home with family and use those beds that I am aware of.

Public health held open meeting in my county recently and suggested county develop plan but health dept. will be limited in assisting county. There has been one meeting of county agencies since then but no real work on specific plan has been done.

I personally feel that instead of renting high end advertising billboards to promote upcoming events, etc., the county should invest in some of those MREs and 270 meals in a bucket at Cosco to set aside to feed the masses at the flu clinics. Gloves, gowns, masks, etc. need to be bought and someone needs to consider fit-testing law enforcement, fire/rescue, etc. Scott Air Packs used in fire fighting are not practical for use in pandemic but N95 masks sure are if we are going to have to utilize our public servantsto help us maintain order and expose them to the AI virus. Who is going to fit-test them and provide them with masks and train them it its use? Has anyone thought of their safety?

Body bags and consideration of mass burials needs to be considered. Funeral homes that can hold 16 EMBALMED bodies in the whole county are not a start. And the neighboring counties will have their own problems-they aren’t going to accept ours.

Decisions of who gets a ventilator will not be an issue, initially. The first ones who need them will get them and will stay on them until they die. By then, there will be so many who need them, it will overwhelming to decide of the many who need the one or two available, who gets it.

I personally feel that not only my area, as much as I have worked to consider all of the obstacles, but all of health care will not be prepared, cannot even anticipate, and will be held back by financial and political constraints, that we will never be really prepared to manage a real pandemic. We will be overwhelmed no matter how well we think we have it together.

I still feel that when I no longer feel safe and can no longer guarantee the safety of my staff, whom I think of as friends and some as close as family, I will have to call it a day, tell them to consider doing the same and say a prayer for those I am leaving behind and go home and close my door.

The Sarge – at 16:56

Melanie -

Comments? They would be welcome.

The Sarge – at 17:02

Kirby -

Thanks for sharing the plan so far! The sum of these perspectives starts to define the gaps that need to be addressed, and maybe a few creative ideas not thought of.

SIPCT – at 17:46

I am not a HCW, but IMO, one step that could be taken now would be to requisition enough blank death certificates for about half the served population of every facility. If TSHTF, the hospitals will be a good place to go to get pronounced, and probably not much else. It would be nice if there were the proper forms. Who knows, the requisitioning might shake up TPTB.

Leo7 – at 17:49

Kirby at 16:56- You are way ahead of the curve. I work at a large teaching hospital with a level one trauma center, burn center, and neonatal center. We are the hospital of mostly the poor. The building sits in the middle of an impoversihed neighborhood where the locals who work ask to go home early or come in late on July 4th and New years Eve so they can climb in their bathtubs before the kooks start shooting into the sky. Yep, this is my house. We are boxed in by a moat—ok a creek but it’s the most polluted creek in the state. We have one building for the medical student library and offices of doctors, and another clinical research lab building. The problems in the other buildings is very few bathrooms and only one shower facility outside the hospital itself. Across the street is a school but it’s about six blocks away. The environment is blighted for want of another word. I’m guessing security will be a major problem. I certainly wouldn’t want to leave the “sense of order and safety” a hospital gives for an alternative care site at that school. A few HCW’s can be overwhelmed pretty quick.

If hospitals in each community would just get together and form a community plan it would be so much better for all of us. But they grouse and snipe at one another and block attempts at adding new facilities, until they don’t seem to get along much. Staff get along but administration sharing resources with others don’t.

 In three weeks, because I’m going back to school, I will work what is called  WOW partime.  WOW is work on weekends, and I plan to work everyother weekend, full time in summer.  I have set aside cash for the last two years by working a lot of overtime so I can do this.  I have always planned on working during an emergency or AF scenario.  

Hospital Administrator’s here is fair warning-Tell us before the wave is in our field of vision what the plan is, what your role will be, how you will staff, feed, and house us and what are the safety measures you have put in place for the staff. Tell us who have made the ethical decisions and how they concluded their findings. Don’t expect to lock us down and tell us then. We won’t be on board for the plan. Include us in the plan’s development because you need us as much as patients do.

Melanie – at 17:50

Sarge,

I think Kirby did a very good job of showing just how much trouble we are in.

The Sarge – at 17:51

I’m not sure even that would wake some people up. The answer would probably be “You have a photocopier, don’t you? As long as they are filled out longhand in blue-black ink, that will be fine.”

Leo7 – at 18:15

Several people have brought up good issues and one that slipped by was from Nsthesia. Staff who work PRN, or as needed. Suprisingly a lot of nurses choose this option just so they won’t feel a connection to some of the BS asminstration dreams up for staff to do; like self evaluations and peer review of colleagues. Time wasters for bedside nurses. These people have no benefits, just pay, and they decide when they will or will not work. If Administration is planning on their cooperation they need to dicuss this with them.

Sometimes I get the feeling some hospitals think the governor’s are going to mandate people with experience in Health care to go to work. Mandates are worthless without enforcement which is why it won’t happen and if it does it won’t work.

nsthesia – at 18:18

I just finished watching the King’s County program that Texas Rose @ 14:04 suggested. It is a very good program.

While watching it, and seeing the numbers (number of patients/number of staffed beds), I realized I wanted to say “one more thing.” :)

Our healthcare system(s) have a very difficult time just keeping pace with today’s routine patient volumes. They are stressed from various directions, including a significantly aging patient population, aging staff population, political and economically-driven policies that conflict with providers’ characteristics, policies that are often devoid of humanistic references to both providers and patients, etc. Many providers face daily personal and professional conflict due to these restrictions.

That is our baseline…

Add any pandemic or other disaster situation, and it is a guaranteed implosion, IMO.

BUT, realistically speaking, NO system is prepared to deal with the mass disaster of a pandemic or biodisaster of any magnitude. I think that is part of the definition of a disaster. If it were manageable, it wouldn’t BE a disaster. <my aha moment>

I am not so naive as to think we could handle (tens of) thousands of patients in a few weeks in ANY hospital setting…with ANY amount of planning. Resources ARE finite. People will die. Systems will evolve.

Hopefully, we can learn to work together to mitigate our losses. I suppose THAT is what this Wiki is all about.

The Sarge – at 18:21

Hospital admins had also better be talking to their labor unions - this is almost always an adversarial relationship in the best of times. Things like standards of care, duty of care and scope of practice, not to mention working conditions, bargaining unit work and labor agreements are going to intrude here in a big way.

Melanie – at 18:33

Sarge,

All you say is true, and I’m a veteran of the labor wars in a different kind of workplace.

All of that having been said, all of the EDs in my metro area on already on diversion for much of each week. Our EDs are already overwhelmed.

SIPCT – at 18:36

And at the end of it all, when the lights are off, the water has stopped running, the food has run out, all the meds and supplies have been expended, there is no PPE left… Is there a plan to get people out without them being torn apart by the mob outside the doors?

The Sarge – at 19:03

Wasn’t one in New Orleans, for sure.

Science Teacher – at 19:21

We have come full circle. We are not prepared. I congratulate all of you who are working so earnestly and diligently in the field to try and find a workable plan. It seems to come down, sadly, to money. Hospitals need it in order to fund their plans, to fund the purchase of Tamiflu, antiobiotics, PPE. They need the money to implement a change in the JIT common practices while there is still time. With so many billions of dollars flowing outward from this country in other ventures it is imperative to turn these funds toward home. Our hospitals can not go it alone. Healthworkers should not be asked to work in a situation where they do not have the basic materials to stay safe. If this turns into an 18 month event there will be no way to restock. Supplies need to be ordered now. Please write your Representative from Congress to ask for funding now.

16 August 2006

Leo7 – at 12:01

Everyone:

Good posts and great discussions. We see a wide variety of preparedness with just our community. NP1′s hospital is at a point that if a fall/winter occurence shows up, their patients have a chance. The Chicago experience seems to be isolated—with some cities at talk stage, others at unknown if any stages. Well, it looks like the game will be won or lost in the ED and triage. Hopefully as HCW’s wake up to the situation those in that area will start to question The Plan. If we see a sudden change in our facilities let’s bring this thread back, for now, we let the mod’s close it. Hopefully we can pull this thread up sometime in the future and laugh at our concerns.

The Sarge – at 12:26

Leo7 -

Yes, let us hope we can laugh at our misplaced concerns! That is much better than the grim feeling of vindication in “I told you so.”

banshee – at 14:39

Can doctors ever abandon their post? from BBC

Are healthcare workers ever justified in abandoning their patients during epidemics of severe disease?…[more]

http://tinyurl.com/zd58n

Found this article written by a medical ethicist on the BBC today. Thought it might be of interest to the HCWs who frequent the wiki.

banshee – at 14:50

BBC Have Your Sayis the discussion board for the editorial I posted at 14:39.

http://tinyurl.com/mpljc

Leo7 – at 15:00

Banshee:

Just read the article and the comments. I loved the guy saying I pay taxes that support national health care therefore I expect healthcare. NP1 also commented on the same point—at what point will a HCW throw in the towel? I believe it will come down to the known CFR if it happens and what every HCW know is the situation at their work. Hospitals that have planned, and discussed the procedure with staff will be open. Those that didn’t will start calling the HCW’s who saw the writing on the wall and quit.

lady biker – at 15:50

I just talked to a RN from one of the big hospitals here and she looked me in the eye and said…….it’s nothing but a bunch of Hype….where to go from there????????

Leo7 – at 16:07

lady biker:

She is in the majority. One of my friends can tick off about twenty other doomsday predictions that didn’t happen. I happily point to HIV And HEP C that have infected from one point to the other on a globe and remind him, we could’ve made a huge difference in CFR if people didn’t believe in the beginning it just affected the gay and Iv drug abusers. People are social animals—if a crowd moves in one direction—people by nature follow it. A small segment doesn’t follow, and watch the clueless crowd pass, I predict the wicki segment is in this group. Here’s my example: Most movie theatre’s have two exits. 90% of the group converge into a big crowd preferring to go out the way they came in. The other 10% follow the exit out-avoid the crowd. Which group are you?

Grace RN – at 16:24

ladybiker at 1550

re: “where to go from there????????”

Try again- give her brief, written info from a well-known source that explains a pandemic is imminent. Look for “the teachable moment”- a time when she may be more approachable.

She may be in denial or scared out of her wits 200%.

TRay75at 16:58

This is in the South Jersey Courier Post today:

You are invited to a Free health forum on

++Avian Flu ~ Pandemic Preparedness++

Prepare for and understand how Avian Flu will impact our community.

Wednesday, September 27, 2006

8:30 AM - 12:00 PM

UMDNJ - School of Osteopathic Medicine

Reservations are Required. Seating is limited. Please call (856)566–6207 or email at [ sominfo@umdnj.edu | sominfo@umdnj.edu ]

I’m emailing a request as soon as finish this post, but wanted you in the field to be aware and contact if you desire to attend.

Average Concerned Mom – at 17:06

Tray75 — gotta love those osteopaths!

TRay75at 17:09

At least someone is doing something around here! I’m finishing “The Great Influenza” and wondering how much has really changed in 90 years. This is the first really major item I’ve seen in print to say “WILL” impact an area.

Leo7 – at 17:16

Thanks TRay75: The historical similarities between now and then is eye popping. And, you’re right “will impact our community” is a new slant.

crfullmoon – at 17:34

SIPCT, I like your idea about pre-positioning blank Death Certificates. I wonder how many/few the clerks have on hand right now? (Same thing with the body bag issue.)

The Sarge – at 12:06, Schools; Principals have been going to “Emergency Planning” meetings, and know their schools are considered “Alternative Dispensing Sites”, or, perhaps hospital overflow, yet seem to have been told not to tell the parents/public about the need to prepare against pandemic, nor mention the federal and state pandemic websites, ect.

Who will be staff? Why, the good-hearted-but-uninformed-about worst-case-Pandemic-Influenza “Community Volunteers”, and, “Medical Reserve Corps” of course!

“Be part of an organized effort to assist your community during a public health emergency” (“You will only be called on to volunteer if there is actually an emergency involving public health”! Doesn’t that sound special?!:-) Sign up!)

Somewhere on the Wiki forum this week I think I saw someone mention choosing overflow sites with an eye to them not being missed if they have to be burned to prevent contagion afterwards. That put a new spin on things for me.

Good ones, Np1: “The calvary that comes to rescue us will be the one with four horses.” and, it seems too common here, too, Little Kahuna at 12:29: …”people are stuck mentally in the 4 phases of denial: 1) They don’t believe it will happen 2) If it does happen it won’t affect me 3) If it does happen, there is nothing I can do about it 4) I knew it all the time, but it is too overwhelming to even think about.”

(By the way, I hearby virtually buy everyone on the thread a big frosty mug of excellent root beer. To your health!)

Are places, locally or on any other level, trying to stockpile morphine and other things they will actually need to use (not just getting on a waiting list for buzzword antivirals or vaccines)?

17 August 2006

Oremus – at 00:49

Every HCW I talk to in Roanoke, VA, gives me, more or less, one of these responses when I ask about their flu plan:

Needless to say, I am not encouraged.

crfullmoon – at 08:31

Hey- new T-shirt idea??

What’s your Pandemic Flu plan?

A) What’s that? B) It’s not gonna happen. C) Let’s hope it doesn’t happen. D) There’s nothing we can do. E) Ha Ha, gotta go (get away from the crazy man) F) None of the above G) fluwikie.com

Grace RN – at 09:25

D) There’s nothing we can do.

This is the most common one I hear-and I answer it- yes we can’t prevent flu pandemics at this time, but you can do a few easy things that increase the chances you and your loved ones will survive it.

About 80% people are then willing to hear more.

Pilgrim – at 11:05

Grace, what are the “few easy things”?

Grace RN – at 11:11

1. Educate yourself-the biggest step of all. And, the easiest to do… 2. Prepare for yourself and family ie stockpile 2 days of food, water, meds, then increase it to 2 weeks, then increase it another 2 weeks…. 3.Educate your neighbors and family

Np1 – at 11:33

I have been using the medium of Grand Rounds in our hospital.I schedule the program, if they want the continuing education and lunch they show up and listen. I started to leak parts of our pandemic plan last month and had about 45 people show up. We do the complete roll out next month. After that I will no longer be working at the main hospital. I will have my own clinic about 45 miles away. You can bet that I will have pandemic flu material out in the waiting room! Kelly

Oremus – at 11:42

I’d be happy if they just said we’ve bought extra masks, gloves, and IV bottles.

18 August 2006

TRay75at 15:45

FYI, Just received my RSVP confirmation to the following - Avian Flu - Pandemic Preparedness program on Wednesday, September 27, 8:30 - 12 Noon, in the Academic Center, One Medical Center Drive, Stratford, NJ. See the link above to email if you are interested in attending.

SIMON – at 15:53

Been on vacation for the last four days,are hospitals ready? hang on i have to get up off the floor where i fell laughing my guts out,this is a joke right? how many ventilators in the US? how many people? yah i think we have a problem Houston

19 October 2006

Closed - Bronco Bill – at 20:28

Closed to maintain Forum speed.

Retrieved from http://www.fluwikie2.com/index.php?n=Forum.AreHospitalsReady
Page last modified on October 19, 2006, at 08:28 PM