My husband is planning a pandemic drill and needs possible case examples. For example there are-and will be a limited number of drugs and respirators the details of who gets help and who is sent home will be difficult. should there be age cut offs-those over 65 get nothing even though this is the group that tends to have the best outcomes. How about age restrictions so that those under 5 are on their own-too awful to imagine. How about the 40 year old mother with three small children and smokes vs the 40 year old childless woman with out children. any ideas would be welcome. come on Hive Mind
He’s got to start with numbers, how many sick, how many beds available, etc. And he has to make some assumptions for attack rate, CFR etc. Whether this is very early on or later in a pandemic. Perhaps he can use the CDC’s FluSurge software to get those numbers, then start from there.
I think we have it on the ftp.
I don’t see a national standard that will encompass these issues. There may be some broad general parameters, but I think these decisions will be left to individual communities and health care facilities to establish. I’ve seen a rise in the number of health care facilities that are establishing ethics committees to deal with exactly those issues you addressed. As anon_22 pointed out, the attack rate, etc. may be differ in various parts of the country and thus the response will vary.
I’m 50 and childless (just a sweet husband and precious cat-children) and don’t think I should receive treatment.
Maybe I should restate what he is looking for…His hospital will be hiring actors to act as sick and worried patients. He is supposed to write 15 case histories or scenarios to run through so that if/when this really happens the medical staff has had time to process what this might look like and some of the hard choices healthcare workers will have to face.
for example…Pandemic flu is in your area and a 36 year old woman with three toddlers all with a cough and low grade fever. Could this be flu? Do you treat? Isolate? Send them home?
A short answer to that is at the very beginning ie when the pandemic virus has just arrived or about to arrive in your area, you should over-treat. ie assume they all have the virus until proven otherwise, in an attempt to limit the spread as much as possible.
When the pandemic is raging, then you consider everyone to be suffering from flu for a different reason, that they probably are. By then the problem is going to be capacity and scarcity of resources.
The aim should probably be to send all except the most severe patients home.
One thought - a friend has athsma and allergy to eggs (so can’t do egg-based vaccines). Just a comment on watching health conditions such as allergies in crazy situations… She also becomes completely disabled in spasm muscle cramps when sick..if someone dropped her there at the hospital, what do you do with someone physically unable to leave or care for themselves?
scenario: you have some cronichal ill pasients, elders, cancer pasients etc, who need lungmachines, then some young and kids come in with panflu, the number of machines are limited, all other hospitals in region is also gettting full.. What to do… Impovise, use the machiens differntly? they have to make some hard deciosions,
Just an example i discussed with someone working in a hospital..
katherine, how’s it going?
(And how many staff would have minor children or elderly relatives cared for at home who could even show up during pandemic, including housekeeping staff, ect?) (Are any roadblocks going to stop essential personnel, as has sometimes happened during blizzard travel-restrictions? How does security know who is supposed to be there and who isn’t?)
What if people are trying to drop elderly or others they can’t care for, such as sometimes happens now? What if women go into labor a couple of weeks early? Including women sick with pandemic? What non-english speakers might you have in your region?
What’s the worst weather-related problem your area has? Ice storm puts the power out, tornado, flooding, wildfire, earthquake, smog alert?
(Have they told the populace about being in a real pandemic alert period, and are your real households stocked up for supply chain disruptions yet?) (What’s the fatality management plan? New rules for who’s allowed to pronounce death and fill out death certificates yet? Then, what happens next for the bodies?)
(Poor hive mind’s a buzzin’…)
Use the planning assumptions posted on the federal DHHS website and throw in a few monkey wrenches. If its’ his first tabletop don’t throw in too many problems as he’ll need to do more later on.
People will be so aghast at the outcomes it’ll take time to sink in.
Like when do we lock the ER and front doors and post an armed guard?
Guard the perimeters of the parking lot, too?
Will the internet/cell phones get all jammed up if everyone tries to contact everyone - did this happen after 9/11?
When does the hopsital run out of fax paper…?
What about: a relapsing middle-aged cancer patient due for his regular chemo, with a mental disorder, say Tourette, running a 40°C fever, deep dry cough, accompanied by his teenage daughter who looks exhausted and stupid. He then tells you his young second wife is in bed at home and does not breathe well, and that she is hot and delirious too. And the two younger children are 5 and 7 and misbehaved, one being a diagnosed hyperactive child for whom they have run out of Ritalin. They had to walk three miles across the fields as there is no petrol to put in the car, and it took them the best part of 2 hours to arrive to the hospital.
What about: Four strong guys are carrying a young women on a makeshift cart. They tell you they found her just outside the town, near some woods. She’s prostrate and shivering beneath the blanket, you hear belaboured breathing and grumbling rattles. The guys are telling you they think she was attacked. On lifting the blanket, you see all her clothing in disarray, bruises are starting to show up on some parts of her partially bare body. She has lacerations on her chest, red marks around her neck. drying blood traces, scratches, etc. One of the guys tells you she has muttered unintelligible words. Another tells you that the walk to the hospital is making him feel tired, you touch is forehead and it’s “boiling hot”. Just at that moment that guy starts a great big coughing fit all over everybody around.
What about: The fire brigade has just contacted the local hospital, asking the ER to be ready to take in patients from a retirement home that’s just burning right now. They tell you this home looked after very ill patients, some of which are already being treated for respiratory ailments in addition to their usual bad health with various cardiac people, kidney patients, alzheimer, well the lot. The nurses/ancillary staff is coming too to help, some of whom do show signs of being unwell. The fire brigade has managed to put them into coaches, the most severe lying in the central aisle, with drips hand on luggage racks. Some patients families have learnt about the fire and are coming to the hospital, completely distraught and demanding that their loved oldies be taken care of. Some of these relatives look of a violent disposition, others start insulting the triage staff.
What about: one of the patients presenting himself at the hospital, say 25 years old, looks like he’s been on the road, has all classical signs of China Plague, is unkempt, looks like he’s had a good dose of pot, stinks alcohol, and addition to all this, when the triage staff examines him, they notice he has a bad case of scabies.
What about: two young children, aged 8 and 9, looking physically well, are coming running, asking you to send someone at home because their parents are sick, they are passing blood through their noses, they don’t move much, they don’t talk, but they have been coughing a lot in the previous hours. They tell you they tried to treat them, but they need a doctor. Their neighbours are either dead, or they don’t open their doors. They’re scared, their hands are dirty with blood they tried to wipe and with food they tried to put in their parents’ mouths. They tell you there is no heating at home, they did not manage to light a fire in the bedroom with the branches they picked from bushes in the garden, they tried to boil water on the electricity which is still on, but they spillt the last of the water. The pet guinea-pig is running loose in the house, but the cat is sitting on Mom’s chest. There is hardly any food left, except some flour and tinned beans, but they did not manage to open the tin and all they could do was pour some leftover juice in the flour and push it in their parents’ mouths.
What about: a young woman comes to you screaming and howling, dragging a young half dressed three-year old child by the arm, which arm is already bruising with her grip. She has obviously lost her head, and also, she’s just miscarried at 7 months, she’s bleeding a little over her skirt, she has disordered abrupt movements. She just cannot stop screaming except when she has a fit of coughing and spitting. She swears at all people around. She’s red hot and perspiring. You have few neuroleptics, the gynecologist or obstetrician is in a protected ward in another part of the hospital. In the midst of all going on, you hear she screams that she’s a diabetic type I also.
What about: There’s a priest who says that most people you turn round to head for their homes are going to die, and he wants to make a tent right in front of the triage area where these people can have the last rites before they go home. The priest is fearless and will not wear protective equipment. He wants to see any person, sick or not, for confession and recommending their souls to a higher being.
If that’s the sort of stories you want for actors, I can give you some more - tomorrow though (it’s bed time here!)
even start with this-
Educated white collar professional has just returned from a business trip to Jakarta. Doesn’t remember any contact with ill people, felt fine last night and OK this AM but at noon has a 40 degree C fever, rales, and rapidly dropping BP. Starts to show slight cyanosis as he’s being evaluated.
BTW, Frenchy Girl, some of yours sent chills down my back. You have an alarmingly vivid imagination!
I assume he has seen the recommendations on the www.pandemicflu.gov site for hospital preparedness. They are here: http://www.hhs.gov/pandemicflu/plan/sup3.html#app2
FrenchieGirl, you’re too scary for Halloween !
Can the communities please go prep, and get free basic safety and first-aid and home nursing courses started for the public now? and, the hospital administrators admit we need some front-line, hands-on staff held SIP at home in reserve for post-pandemic recovery? (and, uncontaminated hospital floors, maternity wards, and ORs, and some basic meds stockpiled would help!)(I would choose saving one nurse over a hundred hospital bureaucrats at this point)
LMWatBullRun – at 17:04 - BTW, Frenchy Girl, some of yours sent chills down my back. You have an alarmingly vivid imagination!
crfullmoon – at 18:48 - FrenchieGirl, you’re too scary for Halloween!
Well, I was in a very somber mood last night - it shows doesn’t it! You may though contemplate that although these short stories stem entirely from my imagination, there is considerable likelihood that such will arise. I am sure that if you ask JV, Anon_22, Grace RN, Medical Maven, Gary Near Death Valley, other people in the caring professions, here or abroad, they can recount similar horror stories seen in their jobs, whether in peace or war, healthy or pandemic times.
Perhaps we should write such stories and devote a chapter on the Wiki for them, just so that TPTB finally understand what a pandemic may mean. Sorry to be so gloomy. I am convinced these are situations to come, not just a theoretical intellectual 3rd grade essay.
I wasn’t saying you were unrealistic! That’s why I want the current plans to stop as they will be collapsed in less than a fortnight.
If the public doesn’t know what we know, they will not stop unvital travel, they will not stock up to SIP for months, if hospital officials won’t acknowlege we’re at risk of a very high cfr they won’t let imported supplies be bought now … if first responders won’t plan for the worst and a pandemic year, if communites don’t get together now while large gatherings and the power grid are still ok and plan contingencies, ect We’re screwed…
We’re screwed - don’t I agree with you! Do you know, what made me so somber last night? It was discussing with a person in a caring profession telling me she knew that she and three quarters of the caring professions would simply die at the outset, in the first wave… I looked at her eyes and I knew she was scared, I knew she would do her duty to her last breath, I knew she knew she would die. Am still as somber today as yesterday…
Always remember: we are the optimists! (‘Cos we think there’s work deserving to be done.)
Shall I create a wikipage with vivid stories? Under Opinion.etc?
Lugon, how about Triage: Emergency Departments And Emergency Rooms - Possible scenarios?
Ok - working on it.
btw, FG, pls email?
I posted a story on the 10/31 news thread about a very intelligent sounding public works program in Wisconsin, U.S. http://tinyurl.com/y6ot3h
In terms of practical funding, is everyone aware of the route they took here to get 12 new negative-pressure rooms for their hospital, along with other pandemic necessities? I am not sure that many hospitals know that these avenues are even available to them to make use of.
<snip>
The hospital also plays a major role in planning. Barb Kuska, co-chair of the Emergency Management Committee at Beloit Memorial Hospital, said each year they can apply for Hospital Preparedness grants through the U.S. Health Resources and Services Administration (HRSA) to make necessary improvements.
“The program was created in response to bioterrorism, but everybody realized early on that it was a multi-spectrum process,” Kuska said.
In the case of any pandemic, the hospital would have to deal with things like increasing capacity, providing isolation - HRSA grants have enabled the hospital to recently add 12 negative air pressure rooms - and having protective and decontamination equipment on hand, Kuska said. <snip>
ok, done - do we add anything to that page? rephrase or introduce?
Lugon at 11:06 - silkski at yahoo dot fr
Add LMWatBullRun – at 17:04, and I’ll correct my own typos later tonight. Many thanks
FrenchieGirl – at 11:14 - done!
I’ll write to you in a minute. Thanks!
BTW, Frenchiegirl: Do you live in Geneva or Hollywood?! You might be in the wrong town with your ability to envision those scenarios. Geneva is so sedate! I lived in Carouge for a while while doing projects for some of those guys in the big box buildings down the road. Loved Carouge. It was very quiet and charming.
Pixie – at 11:31 - Shhh… Now it’s in the public domain. If I’d known I should have kept my talents to myself, moved to Hollywood and become filthy riiiiccchhhh :-D I work in Geneva, and live in France. Carouge is the place where I go for second hand goods. It’s so nice and quiet here, never anything happening. The local hospital (2000 beds, three times that in staff, has _exactly_ 5 isolation rooms in the basement). Population in Geneva is 350 000, or almost 800 000 if you count neighbouring France. Hate to think what will happen when TSHTF!
Katherine - do you need more scenarios?
Tell us how it goes.
uhhh I meant about Mr.katherine’s pandemic drill - not when TSHTF…
Can the hospital staff, and surrounding communities, get handed the Flu Wiki address, somehow?
Here’s a medical care plan from Utah that I find very interesting. The state is worried about providing “legal protection” for HCW who will be deciding how health care will be rationed. http://tinyurl.com/ycs2w5 But at least its being realistic as to the lack of facilities and care that will be available.