a quick question just to confirm (or not) something I’ve been wondering….
I’ve lately had the feeling that the severe effects of a pandemic have been taken very seriously by people (and institutions, i.e Homeland Security, Bioterrorism experts, etc.) involved in disaster preparedness; not so much by those in the medical field (AMA, Drs., etc)
I can’t say I can prove this — just that it is what I’ve been gleaning overall from comments people have made, and by who the authors are of the more “alarmist” commentaries in the paper.
I don’t mean individuals — I know plenty of drs and nurses are concerned — but I mean in public, people speaking out, writing letters and so on.
I can’t explain it more clearly than that — does anyone know what I am trying to say? If I am correct — is there a political reason whyy this should be? A psychological one?
Average Concerned Mom. I would never have thought of it that way…and I think you are exactly right.
I have great respect for H5N1 but I am not overly afraid of it…because by now, it is a fixed variable…as far as virulence goes it isn’t going to get worse…
…I am very concerned and a little afraid of societies response to H5N1…that is the great unknown in all of this.
I think that the WHO has done a very good job of downplaying the medical issues and professional opinion reflect the fact…I still think they are gambling and have convinced themselves it won’t happen…there attempts at telling the scientific truth now is half-hearted because it is hard to get away from the deliberate misleadings of the last few years…in other words, it’s hard to put the genie back into the bottle
I do think the doctors are waiting on a mandate from the AMA. Right now both the AMA and the ANA (American Nurses Association) are putting out mild info on flu, bioterrorism etc, but they are dwelling on ethical circumstances. One of the RN journals last month had emergencey scenario’s with choices for the reader to select. Each choice was discussed. They are heavily promoting “Duty to Care” and the Patient Bill of Rights. This is all sweet except meaningless if the institutions don’t prepare. AMA and ANA can’t make the instiutions prepare. Here lies the Catch 22. HCW’s will be faced with a really tough choice—SIP or Work. If a hospital leads it will prepare and staff will stay in greater numbers. Non prepared hospitals will have mass resignations. The bottom line is most doctors (not all, but the majority) visit hospitals for rounds and leave except for ED docs. Nurses, resp therapists, lab workers etc, man the house 24/7. It really won’t matter what the docs decide, it’s what the people at the house decide that will count.
Actually, it will matter what the docs think… They may not be in the hospital except for rounds, but they are in their offices seeing patients for an average of 8 hours or more.
At my hosptital and others where I have worked….
0600–0830 = Docs make early rounds at the hospital. 0830 - 1230 = Docs see patients in their offices. 1230 - 1400 = Docs eat lunch, and maybe see critical patients in hospital or go to the ED to admit new patients. 1400 - 1730 = Docs see patients in their offices. 1730 - 1830 = Docs see patients in the hospital.
Then they go home, to do it all again the next day.
This really is fairly standard wherever I have worked. Take it as it is…… I hate to admit it, (really) but doctors do put in the hours.
That being said… In a pandemic, the docs will have their offices full to overflowing with patients. They may also have to see tons of patients in the hospitals and outlying facilities.
So, There it is….
Tom DVM at 16:24
I humbly submit a more apt analogy for WHO’s current behavior.
It is difficult now to let the Genie out of the bottle, after claiming for so long that there is no bottle, what do you mean a bottle?…even if there might be some bottle (and we are not saying there is one, mind you…) there isn’t a genie in it!!
The hospitals will close. There will not be enough nurses to staff the hospitals. It happens every day. Hospital go on by pass because the are full, no beds or not enough staff. It happens in summer months and especially in winter months. They close for a few hours or a half a day or so and then re-open. In a pandemic, they will close their doors, or only take very critical patients. I doubt they will take in flu patients and risk more staff getting sick. Just my opinion.
The hospitals and pharmacies will burn in America. Remember, our population has been trained and engrained with the twin ideals of zero risk tolerence and American medical care can cure all. This explosive combination will cause cognitive dissasociation when agitated dad shows up with sick johnny or stephanie dying in his arms, and refused admitance. Expect the resulting mental breakdown(s) to be violence. My 2 cents is that rioting at the hospital will kill more doctors and health staff than the flu, even at rates as low as .5 CFR. Unless you have held your dying child in your arms, believing that they can be saved if treated, you do not know how primal the reaction is.
Ruth,
I can only speak about my hospital… What you have described is not in our disaster /pandemic plan. Our hospital is part of a larger network that will take care of patients. It includes ALL types of medical facilities, businesses, public health, EMS, private ambulance services, physician offices, alternative care sites, Nursing homes, etc.
It will certainly not be ideal, but we at least have a plan.
If more doctors, especially primary care physicians, were on board, they could go a long way to convincing people to prep. The average Joe may not believe Uncle Sam (especially post Katrina, email scandlas, lobbyists, etc.) but if his doctor tells him he needs to fill his BP script for three months and stockpile food and water, I bet joe would listen.
Florida Girl, I’m glad your hospital is on board. Many hospitals are not. In order for this to work, we need all hospitals and medical facilities to be prepared. I don’t think this is happening throughout the country.
FloridaGirl:
Are you still on bedside duty, or have you been doing 100% planning? I think it’s fair to say that doctors offices will not stay open because their staff, usually not that many RN’s will not show up. Doctors make rounds and write orders yes, but they don’t hang around hospitals, they elect other doctors yearly to make hospital decisions for them as a group. The exception is teaching hospitals. Teaching hospitals have the students of all types, not the private hospitals. Docs associated with private hospitals can’t take call, work in the hospitals and keep their offices running. If they told you they could—they lied.
Their operations depend totally on their support staffs. Someone to call the patients back to treatment, answer the phone, someone to create the order. Are you saying that private doctors offices have stocked for their staff including PPE and food? Your whole operation is based on the lower wage people showing up to work-if you have the right PPE in the right quantity, food and housing then you may be as you state at 20:52. But if your house is like mine, requires staff to drive in to work daily—that staff person will have plenty of time to reevaluate the futility of what they’re doing while they’re exposing their own family to unacceptable risks. If they’re exhausted because they believed the hospital was prepared and only 10% of their colleagues showed up, do you as a planner expect them to return the next day? If society breaks down around the hospital do you really think you can stop the staff from leaving to protect their families? NO.
The problem is—will all wage earners from janitors to doctors show up DAILY? Is the 30–40% absentee rate correct for medical institutions? No, it’s not. Picture your docs for just a few seconds mopping floors, delivering meals, changing linens? Heck, I don’t intend to cook or mop myself, the moment I’m asked to do it will be the moment I know the hospital has lost the battle. If the CFR is high, even if you turn the place into a fort there won’t be enough people to run the place. My conclusion has been for sometime hospitals in an area of infection will be lucky to last two weeks.
Leo7 – at 11:32 I agree with you - I also do not think I will see many physicians pitching in and helping to feed, bathe, or empty bedpans, cleaning or cooking. Many MD specialists will not show up at all, so who will be the ones that will need to come to a hospital setting? Internists? GP’s?
Many cooks, housekeepers, nursing assistants are poorly paid - I doubt they will stay on the job if there is a high probability they will get sick. I think we also need to keep in mind that they may not be able to come in to work because a lack of gasoline or social disruption. Lack of food, cleaning solutions, etc. may also curtail these activities.
Medical clinics have not been involved in the pandemic planning process in my state. That means they will not have any extra supplies (PPE, etc) for staff and definately will not have food, heat, or other things necessary if utilities/shipments do not occur. IMHO, I do not think clinical staff (MD, RN, ancillary staff) will show up for work and the clinics will be shut down. These staff members are not going to show up to a hospital to help out. It is highly likely that these individuals who do work are not going to be reimbursed for their time by medical insurance companies (the insurance companies are not going to pay the same going rate for their customer to be placed on a cot in the hallway with no staff to care for them, no medicine, no food, no linens,…). How do hospitals plan to get reimbursed for the care for these patients (especially if they are treated outside of the hospital)? How will they pay the staff members that do show up?
There are a lot of questions and not many good answers for them.
Leo7,
Unfortunately, I agree with you and Ruth.
FL Girl, what are your hospital’s plans? Will there be a “lock down” of the employees? Will there be a surge capacity of 200% or greater? How many weeks of supplies, food will be available? Are you in administration or in a clinical position? New or seasoned? Have you seen the pandemic plan, or is it a generic disaster plan? (The latter do not work for panflus.) Are you in a for-profit or not-for-profit? It costs a LOT of money to prepare for a panflu. Not too many institutions spending money on staffing, let alone preparing for a “potential” disaster.
Just wondering…and where in the state ARE you? Sounds ideal…
I did analysis and modeling on this topic for my organization, which supplies blood and blood products to many hospitals to assess the demand for RBCs, platelets and plasma. My conclusion was that if the clinical attack rate exceeded 5% that there would be problems in hospitals staying open, and if the CAR exceeded 25% that we would certainly see a wholesale shutdown of the health care system and thus very little demand for blood products. We expected the shutdown to occur within 2 weeks of the reported index case anywhere in the US.
In summary, my expectation is that in a 1918 style pandemic that there will be no effective health care within 2 weeks of the onset of a severe pandemic. I also agree that John Q. Public will not accept that, and the results are likely to be very violent. Moreover, the violence is likely to break out unpredictably, and once it starts to be widespread against HCWs. See the Pandemic Song thread for a rather chilling example of how people may view this issue.
Leo7 – at 11:32
Sniffles – at 12:35 nsthesia – at 12:51
Man! You guys are truly depressing. If people do not try to make things work, then it definitely will not!
Some answers to your questions:
Technically, I am not in an administrative position. But, my position does allow me to work with other local hospitals. I make decisions affecting the processes at the hospital(s) almost daily. I do have a huge amount of autonomy in decision-making, and I am able to decide the best way some things would work or work with people who may know better than I, how best to approach a problem.
(Case in point: Dietary, to work with them on how to feed staff and an increased patient population for an extended period). And no, we are not going to lock our employees in…. We will however provide them with a place to stay if they wish, and food to eat. Also, Not new…. Been a nurse for a while… But, I also have experience in other areas outside medicine.
No, I do not do disaster planning 100% of the time… But, part of my job is to work with the people responsible for planning.
No, Pandemic Planning is part of, but separate from our overall plan. Truth be told, hurricane planning, chemical, nuclear, Mass casualties, etc. are all different plans that are wrapped up in an umbrella disaster plan, some share the same components, but they are still separate. Pandemic planning looks at things in the long term, with different problems to face. ALL of the above plans include the roles of outside agencies. i.e. Public Health, Law enforcement, EMS, etc.
As far as the doctors…. I am working with a group of them to determine triage criteria that will be used at the hospital, physician offices, walk in clinics, nursing homes, alternative treatment sites, alternative triage sites, etc. This is a county effort, and all are included. Even those who do not work in the hospital, and those who are specialists, etc.
As far as nurses and other staff doing menial chores… our hospital has already set that precedent after the passing of a couple of hurricanes. We all pitched in and cleaned. We had Doctors stocking the supplies and hauling the medical records back into the facility.
I am not saying we are building a plan that is foolproof… but we have a plan. And the hospital is just one part of the bigger plan to take care of the people in our county.
Yes, I and a few others also work on the County planning committee… this is led by public health, advised by a regional planner (State directed), and attended by many people that will make a difference because of their roles in business, infrastructure, communication, etc.
Will staff stay home? I don’t know…. Many staff are also a part of the planning. They certainly do not share the same mentality as you guys are showing…. They are not known for giving up. And that includes housekeeping, radiology, cardiopulmonary, medical records, admitting, and all the rest.
As far as insurance companies paying. Of course they pay the same rate… why would you think they wouldn’t? The state of Florida is also looking at a way to supplement costs related to the uninsured. You should not speak about subjects of which you know nothing.
I think that the more people who become involved at the level where it matters the most… many problems can be looked at and at least partially overcome.
If we, and others around the country do not keep a somewhat optimistic outlook, then not only will nothing get done, but the chance of failure approaches 100%.
I know that the plans our County and hospital are putting in place will not only save many lives, but will surely lessen the impact on our health system through at least part of each wave.
Will it be enough? I don’t know… But, I won’t stop trying… and I know I am not alone in this effort.
I agree with Florida Girl 19:58
Old story…. A man and a boy were walking along the beach after a storm had washed thousands of starfish up onto the beach. The young boy picked up a starfish and tossed it back into the water. The man said “What difference can you make? You can’t save them all.” The boy said “I made a difference to that one”.
The Hospitals, Nurses, Doctors and ancillary staff will save lives. (They will be able to save more with planning.) Most of the HCW’s I know will be there as long as possible. But the reality is that most people who are sick during a pandemic will not have access to sophisticated care.
Newcomers should pay attention to the information available in these FLUWIKIE topics. Self-preparation is the foundation for community preparation.
In a pandemic of any severity…Every person/family who is self sufficient and doesn’t require medical or community resources will also in effect save the lives of others in addition to their own.
Adirondack – at 20:53
Your story has meaning. Each of us has an impact on other people’s lives. It is up to us whether that impact is positive or negative. That is what fluwiki helps us to accomplish… Finding the solutions to make that impact a positive outcome.
Fluwiki has strength in the creative abilities of individuals working together for a common good. This is the same concept of communities having citizens working together for the common good.
This is not just a fantasy world in the computer. We need to take these ideas, knowledge, and creativity found here on fluwiki to our cities, towns, and counties and make them happen.
It IS great that most of us are preparing, prepping, planning… And that will help, also; but, sometimes… it is not “all about us”…
JMO….
Florida Girl:
Well you’re on a self high looking down on the rest of us. While I cannot and don’t speak for the others you’ve tactifully called depressing, I would like to point out in my own defense that I’m not on antidepressants and I don’t wear rose colored glassess either. I just wrote what everyday staff nurses talk about among themselves. You write like you work in Staff Development or a similiar positon since this is about the only department that links up between other hospitals. Housekeeping and janitorial services at most hospitals is staffed by temporary workers, and they have no benefits. How nice for you that yours do, and they are happy enough to stay and work in a worst case scenario which is what we’re discussing here or did you forget?
I thought the purpose of posting was to give and take and expect people to question you. You respond in attack mode, the haven for insecurity. I’m glad you have “a plan.” My hospital has a plan too, but it’s all on paper. Yours sounds pretty—I like the way you say “We’ll feed the staff if they want to eat here.” Well I hope so, otherwise what, they leave and go to McDonalds? You write-You should not speak about subjects of which you know nothing.” Right back at ya!
this is just not a fantsy world. we work FOR Aiving and we can die for one too. Work-real-hard or we are goin to come-after u. I’m sick of payin’ these taxes.
I put this on the news thread, but I am also putting it here in hopes to catch up with our newest poster.
rph: Welcome to the Fluwiki. You will find the information here useful in ways you could never imagine. Anything and everything about any kind of self-sufficiency is here in addition to breaking influenza news and forum topics on just about any subject even if only tangentially related to H5N1.
One thing, though…while everyone here is happy that you have used a “name” since hearing from hundreds of different “anonymous” types is a source of aggravation for many, you may want to consider a slightly modified name. We have someone who posts using “RPh” who is a registered pharmacist and many of us look for his/her posts to find out about drug-related issues, so, unless you want to be bombarded with questions about how long you can continue to use a certain drug after its expiration date, you may want to use something that is more uniquely you.
We’re all glad for you and for your grandchildren that you have found the wiki! Careful, though…it can become an obsession. :)
Florida Girl,
I’m interested in your hospital’s plans because my local hospitals aren’t planning and I have a relative who is a healthcare worker.
Does your hospital have the massive amounts of PPE in house that will be needed for your staff?
Are you planning for all of your staff to remain in house? If they go home they will risk infecting their families.
How will you maintain staffing levels as your staff becomes ill?
How will you have adequate security?
Speaking for myself and my family, I hope enough HCW’s are smart enough to take precautions and not be martyrs so we have some HCW’s still above room temperature after this thing is done or at least dying away.
Planning for the aftermath is as important as planning for the Pandemic, which sometimes gets overlooked since there is not as much urgency attached to the aftermath.
FloridaGirl – at 19:58 you stated:
As far as insurance companies paying. Of course they pay the same rate… why would you think they wouldn’t? The state of Florida is also looking at a way to supplement costs related to the uninsured. You should not speak about subjects of which you know nothing.
Well, since your comment seems to be directed toward me, I feel I should respond to it. I have worked in healthcare for about 20 years and currently work in public health. Many of the hospital officials I have talked with are not as confident as you about large numbers of staff coming to work (either they will not come to work due to transportation issues, illness, or fear of becoming ill). My husband works in the health insurance industry. Have you spoken with the insurance companies in your state about how they would handle a potential pandemic situation and how they might reimburse for care? From what I have heard, medical insurance companies seem to be just starting their planning (many haven’t done much of anything yet). I am not as confident as you are about reimbursement rates remaining the same. It would not be a big shock to me to see the same debate as was seen during Katrina and the property insurance companies (water vs. wind damage and who is going to pay). A pandemic will be a huge drain on medical insurance companies, so IMHO, they will be trying to find ways to keep afloat and reducing rates of reimbursement will be one of them.
homesteader HCW are not suicidial. We routinely expose ourselves to risky situations. We will take care of ourselves. Thanks for caring.
Leo ditto. The planners are not the front line staff. They are making some critical errors in thinking. I hear over and over the mantra of off site centers as the solution to all their problems. Nobody has addressed how these centers will be staffed. Not one nurse or nurses aide I know when presented with the facts of H5N1 and lack of PPEs are going to work in a pandemic. . The planners are assuming that because we are in a caring profession we are somehow going to subject ourselves to high risk patient care with little or no PPEs. We on the front lines know better, we do talk amongst ourselves. The planners are going to have a pandemic without the front line staff.
Florida Girl Im afraid that because of your position the staff nurses are not being honest with you. If you do a anonomous survey asking staff nurses if they plan to work if PPEs are not avail during a H5N1 pandemic you might see a different picture. Nurses on the front lines that I have spoken to have no intention of showing up. Leo is telling you the same thing. Being in management I fear is giving you a vastly different picture. I frankly would not be honest with a manager who questioned me, Id tell you what I thought you wanted to hear. Most nurses have given up on management, to much water under the bridge over the years. you may think your hospitial and your staff is different, but somehow I dont think thats the case
janetn;
Bless you for speaking directly at the issue. I’m a high school biology teacher. My middle school aged kids will be staying at home at the first verified sustained H2H2H. . .anywhere in the world. They have been home schooled in the past and we have raised them to be self-reliant thinkers. I’ll continue to go to work until it arrives anywhere in the northern hemisphere, then both my wife and I will be home with our kids, goats, rabbits, preps etc. . .and the gate closed across the driveway.
My first responsibility is to my wife and children. I need to be healthy to fullfill that responsibility.
Leo7 – at 00:51
You wrote: I would like to point out in my own defense that I’m not on antidepressants and I don’t wear rose colored glasses either.
I apologize Leo7… I did not mean that you were depressing.
Sniffles – at 15:39 You wrote: Well, since your comment seems to be directed toward me, I feel I should respond to it.
I apologize to you also Sniffles. It was not directed at you. I did not even know who had written it.
I was angry, I admit, But, I should not have responded in that way. It seems every time someone posts with information about planning activities, or requests for assistance in planning a hospital response. That person gets bashed by those who say there is not any point in trying to prepare. It just seems that the last few times I have been on here, this overwhelming barrage of people who believe that nothing should be done, let me know that the world is absolutely going to hell in a hand basket. (Clarification: Not you two… ).
I am certainly not saying that we will not see a VERY bad outcome, no matter how much we plan. I am acutely aware this might happen. All I am saying is we are building a working plan, with people who are concerned, but who also want to make a difference.
As far as not knowing what our nurses really think. Well, maybe you are right. My feeling is…. They will be right there, doing their best. 25 years ago, I was in high school with about 15% of the staff. Another 20% I have worked with greater than 10 years. Another 10% I have worked with between 3 and 10 years….. (This is not just nurses; this is maintenance, lab persons, cardio, radiology, nurses, and doctors.). I don’t see them acting out of character, especially since many are involved.
So, if you accept my apology, and want to discuss the pro’s and con’s…. What might work, or what might work better. Then I will certainly listen.
My inlaws are both HCWs in the prison system of Colorado. I can’t begin to express the nightmares I have for them or for BIL and SIL who are guards in the same prison system as MIL and FIL. When I read about projected outcomes(ending badly) at civilian hospitals I can’t help but wonder what will become of the neighborhoods surrounding our federal and state prisons when TSHTF. Just like civilian hosptials, they are already stretched to the limit with HCWs and guards and when no one is able or willing to show up for work….. I can’t imagine the worst of it.
I just wish I could convince them of the possibiltiy of a pandemic.
Florida Girl,
I’m glad you are on the board and actively posting. Sounds like you are in an excellent position to positively affect the lives of many people. Keep up the good work, keep posting, keep prepping.
Shoot, was on my wife’s laptop and forgot to authorize the above.
Florida Girl, I applaud your motives, your at least trying. I fear that too many of these plans are going to become unworkable simply because assumptions were made that arent based in fact. Does your hospital have enough PPEs [esp N95 masks] to last through the first wave? That IMO should be the number one priority in any plan. I havent seen a hospital yet that is willing to spend the money to protect the direct care staff. I pray your facility is different. Without PPEs you cannot expect the staff to risk their lives for want of some $2.oo masks its just not right.
Off site clinics are fine and good if you have the staff infrstructure and support staff identified and briefed on the true conditions of these sites, and what they realisticialy will be able to offer in the form of tx. I havent seen a plan yet that does any of the above. Some plan for retired volunteers, CERT train volunteers and I dont know what else. Instead of reinventing the wheel what about using already existing LTC facilities. As unpleasant as it may sound LTC facilities are going to end up with a lot of empty beds early on. Can two LTC facilities be combined into one freeing up one facility for flu victims? You can then use the existing staff and infrastructure ect. then you can agument them with volunteers, it wont be perfect but I sincerly think its a more workable alternative then starting from scratch.
Again back to my originial premise without an ample supply of N95 masks any plan has doomed itself to failure. It is the foundation that will keep the system from utter colapse
janetn – at 23:42 Does your hospital have enough PPEs [esp N95 masks] to last through the first wave?
Not yet. It appears some supplies are on backorder. Funding has always been an issue, But last year and this year the hospital has received a grant (CDC? HRSA?) to help with hospitals getting ready for a pandemic. This years money is going toward PPE, and medications to treat secondary bacterial pneumonia infections.
You wrote: Some plan for retired volunteers, CERT train volunteers and I dont know what else. Instead of reinventing the wheel what about using already existing LTC facilities.
The public Health department is responsible for staffing the alternative Care (Treatment) sites. My understanding is they will do the above also, but they are also planning to redirect the nurses who work for DOH in our area to staff the ATS. The home health nurses in our area also have a role, but I am unsure of what that is exactely.
As far as LTC facilities, they also have a role. See the Clinical guidelines from Canada posted on the “Need triage Criteria for hospital,ATS” Thread to see a basic outline of how some things will work.
Florida Girl Has the DOH contacted the home health nurses and advised them of their role in the pandemic? For instance in my state HHN are also in the planning for ATS problem being they have not contacted these nurses to inform them . Again I fear plans are being made that are not realistic. How do you judge your potential staffing levels without an accurate picture of how many will show up.
A survey was done in NY a year or so ago it showed that for bio attacks natural disasters ect. most of the staff would show up. But when they asked about H5 things dramaticly changed 50% admitted they wouldnt be coming to work. If your front line staff is a no show the plans fall apart. Somehow you have to get an accurate picture of who and what you can plan on for staffing not only in the hospitials but the ATS, if the majority of staff that is planned for is a no show the sites wont function and the hospitials will have to pick up the slack, the system is interconnected. Weakness in one area will effect the others A survey like the one in NY will give you some idea of what your going to have for staffing.
In my county’s plan it specifically states the flu patients will be warehoused in alternate facilities, and the goal is to keep the hospitals up and running for OTF (Other than Flu) critical care.
There is absolutely NO surge capacity in the system. They are already running over capacity during a normal Saturday night.
I too see a HUGE disconnect between what we are being told as first responders from DHS, and what we are told from the county health department.
Oh and I forgot to add, they also plan to STAFF those alternate care facilities with para-professionals like firefighters and EMT’s.
As if….
Bird Guano you have said what Im trying to point out in a much shorter clearer way. The bottom line is there is a huge disconnect from what the boots on the ground see and what those doing the planning are assuming. This is going to be a fatal error.
Florida Im just trying to get you to see that without realistic staffing numbers you have no workable plan. There is a major disconnect here. Either what Im and Leo hearing from direct pt care staff is wrong. Or your right and your area/hospital is far different from mine and Leos. Either way planners have to find out the truth before a pandemic plan is implemented.
BG, and, they probably haven’t bought any supplies to run those ISCU’s, because they’d have to make clear why they need so much $, and they certainly haven’t told the public, who they want to volunteer “to help if there’s a medical emergency in your community” what an influneza pandemic with H5N1 would probably look like, nor how long it might last, nor are most of the parents set to cope for even a fortnight.
Unprepared people outnumber any plan on paper.
Where is the food, how is the electric grid staying up? Who is writing the death certificates and how are the bodies going to be buried? The people you want to run security - had they been told, do they even live in your municipality, are their familes ready to SIP for a few months?
Show up and try for two weeks? no ammount of dedication and trying is going to keep unprotected people from falling ill and dying, and then what?
(mcjohnston92 – at 18:47 : Majority of Public; “Who’s Jeannie?”)
Those in disaster fields do encounter disasters; perhaps they can extrapolate what a non-local, non-time-limited, no outside aid disaster would entail better that some medical field people, especially those who have never worked through a disaster, nor in a country whose government fell, nor was a third world medical volunteer, ect; can’t imagine something that has never happened in their lifetimes; a 1918 or worse global plague, where sheer numbers will overwhelm current system?
We shouldn’t have had health infrastructures just for profit; we should have had prioritized good health infrastructures, with well-paid front-line staff, because a healthy functioning populace is a national security issue.
Many state plans (I know ours is) seem to be depending on “volunteers” to help with reduced staffing numbers at hospitals or alternate patient care sites. My contention is that these pools of volunteers will not be there during a pandemic as they would after a tornado or other natural disaster.
I cannot remember which state on the east coast it was (one of the threads discussed it), but one of the things on the list that this particular hospital was doing for pandemic preparedness was talking with all of the state health insurers to see how they would reimburse their hospital during a pandemic and was also in a dialogue with the state medicaid program to see how people who could not pay would have their care covered. Having these types of discussions prior to a pandemic may uncover issues/problems that may not be evident now.
Homesteader – at 21:56 Thank you…
janetn – at 10:03
Florida Girl Has the DOH contacted the home health nurses and advised them of their role in the pandemic?
Not officially. There are several independant home health agencies and 2 large home health agencies associated with hospitals in the region. There has been some talk between the county and home health, but, nothing is specified, yet.
you wrote: How do you judge your potential staffing levels without an accurate picture of how many will show up.
That is a good question. I do not know how the County is judging how many will show up. I do know that Florida has 13 medical Reserve Corps, which from my understanding is quite a lot. (For example, I heard Alabama has 2). It was also discussed at a meeting a couple of months ago, about the number of CERT’s that has “agreed” to staff in the event of a pandemic. The committee was planning the education that will occur over the next few months.
I also know that the County has received phone calls from retired medical persons that wanted to be put on a list to be called, but the County has not gotten that far yet.
The State also has a role in staffing somewhat… (Now, In my mind, This one I am not counting on…) From the Florida Pandemic Plan
Duties: 1. Maintain current inventory of DOH employees, including CHD staff in affected areas. 2. Inventory includes: a. Name. b. Profession. c. Normal job location. d. Normal job supervisor and contact information. e. Assigned location for event. f. Assigned supervisor or coordinator for event and contact information. g. Date and time of activation. h. Date and time of deactivation. i. Verification of return to home station. 3. Routinely contact Logistics Staffing Unit’s Florida public field staffing manager to maintain current inventory of DOH staff placements. 4. Routinely contact Logistics Staffing Unit’s private staffing manager to maintain current inventory of non-DOH staff placements. 5. Routinely update inventory to show secondary deployment of personnel. 6. Routinely update inventory to show demobilized staff resources and confirm their safe return home. 7. Maintain inventory to show all entries made to the inventory for after-action analysis. 8. Provide twice-daily summary reports of resource deployments made, by categories and locations, as needed in planning for an event. One summary report will be provided early in the morning and another late in the afternoon of each day.
The above is somwhat representative of what the county also plans to do to ensure staff at any / all medical sites. That is about all I know about the County plans. Although, We have ameeting coming up and I will ask.
Tha hospital has not done a survey, although it would probably be a good idea. I will have to see how such a survey could be conducted, and whether it would have to go through IRB.
Bird Guano – at 10:10
You wrote: In my county’s plan it specifically states the flu patients will be warehoused in alternate facilities, and the goal is to keep the hospitals up and running for OTF (Other than Flu) critical care.
Last week,(I think) there was supposed to be a meeting with NIH to discuss this very issue. They were going to look at the feasibility of that concept. I do not know anything else, and I can not find anything written up about it.
Bird Guano – at 10:13
You wrote: Oh and I forgot to add, they also plan to STAFF those alternate care facilities with para-professionals like firefighters and EMT’s.
That is not in our plans. EMS has an entirely different role. They will work as triage in the field, and transport patients. Firefighters has not been discussed, to my knowledge.
crfullmoon – at 10:53
You wrote: they probably haven’t bought any supplies to run those ISCU’s, because they’d have to make clear why they need so much $, and they certainly haven’t told the public, who they want to volunteer “to help if there’s a medical emergency in your community”
If ISCU’s means the same as Alternative treatment sites, then the answer is yes, they have. I did ask about this some time ago. Apparently the county has also received grants. The money has been spent on PPE, and antibiotics, and some other medical stuff for which I did not get details. They have also bought generators for the ATS’s. I also heard they will be recieving a grant in the very near future, which they were dicussing how to spend at the last meeting, but I cound not stay.
The only part I heard talk about was the setting up of the phone bank, which they want in place to help provide support to those who are ill or providing care for others at home. It will also work as like a phone triage.
As far as telling the public. There have been MANY presentations to the public over the past few months. The Public Health dept receives calls from interested parties, and then they set up a presentation. This is a reoccuring theme, I have given presentations to some of these groups. The County has also made up brochures. They put them in all the newspapers, put them in public places where they can be picked up, Given some to the hospital, and doctor’s offices, and they put them into packets and give the info to all clients that they see, whether they are on WIC, or there for classes, or whatever….
I should add, that a grant payed for the printing of the brochures.
Sniffles – at 11:15
You wrote: but one of the things on the list that this particular hospital was doing for pandemic preparedness was talking with all of the state health insurers to see how they would reimburse their hospital during a pandemic and was also in a dialogue with the state medicaid program to see how people who could not pay would have their care covered.
I can tell you a couple of things on this. 1. I personally talked to BCBS and they told me they would pay for a covered patient under the terms of their coverage. i.e. if it said they pay 80%, then that is what they will pay. I would hope that other insurance companies would also pay…. but, I did not call any others.
2. The State is looking into helping pay for patients that are uninsured. This information was given by Jeb Bush at fuction I attended. Where they are in this, I don’t know.
3. The Florida Hospital Association is also looking into how payments should be made to alternative care sites, that may have public health, state employees, CERT, etc. that are working together for the public’s health. (Now, I do not have first hand info on this, but it came from a reliable source.)
And you are right, Having these conversations before, would relieve a lot of people’s stress levels.
“Bird Guano – at 10:13
You wrote: Oh and I forgot to add, they also plan to STAFF those alternate care facilities with para-professionals like firefighters and EMT’s. “
Now that’s downright SCARY. One of my nightmares is that someone will start a fire that will travel from house to house taking out an entire (my) neighborhood, and there will be no firefighters to stop it because they are all sick or dead. If they were pulled off their primary duty, fighting fires, to take care of the sick, that would just about guarantee that they wouldn’t be available when needed.
Wouldn’t the EMT’s be the very first ones to get the flu and then pass it on to their families? Do they have enough gloves and masks for thousands of people? Does the hospital have enough food stored for all of these people and staff? Where will the hospitals obtain the food, linens, medicines, IV’s ect. after their supplies run out? With the hospitals compleyely full where will the staff sleep, if the stay over? In our state the fire dept. has to go out on every EMT. call and vive versa. Wouldn”t the fire fighters be exposed with the EMT’s?
I fear the sad truth is that there won’t be enough of anything, and that after not-enough runs out, there’ll be nowhere to obtain replacement supplies.
I suspect any existant hospital staff will accept the fact that they’ll sleep when they’re dead, and stay on their feet far longer than anyone would believe possible.
Anyone who isn’t actively self-isolated will be at risk of infection.
He thinks I’m crazy too – at 15:19
Wouldn’t the EMT’s be the very first ones to get the flu and then pass it on to their families?
EMT’s would wear PPE for certain types of calls if it became known that AI was in the US. (Depending on the location of AI, they may very well wear them to all calls)
EMT’s are trained in infection control. But, depending on the phase, the severity, the transmissiblity… then your answer would be that EMT’s might be at higher risk at certain times.
YOU GO F-GIRL!!! Eisenhower said “Plans are useless, but planning is paramount”. We are developing plans and will probably be only a fraction right, but we will adapt and do best we can. I really don’t want to crap in a red bag, but I can live in poor “austerement’ for a while before I cave and a lot of people will feel that way WTSHTF.
Would you please answer all of the questions? @ 15:19
Another question----Do we need HOT WATER AND BLEACH to kill the virus in linens? If so, how much bleach per gallon.
He thinks I’m Crazy too…. I am assuming you are asking me to answer the questions. If I am wrong, just ignore. (Question: Who thinks you’re Crazy?)
He thinks I’m crazy too – at 15:19
Do they have enough gloves and masks for thousands of people?
By they, I’m guessing you mean the public health department or the hospital. And the answer is no, However, we have less than 100,000 in the county. The public health department has already started aquiring PPE. The hospital is ordering PPE. Apparently there is a backlog of orders for PPE… (Imagine that….! That actually sounds promising, because somebody is ordering them).
Does the hospital have enough food stored for all of these people and staff?
Again, No, not yet, but it is being ordered (already approved for funding). It is my understanding the order will be large enough to feed the patients (100% surge capacity) The staff, and some familes.
I should add here.. there is an entire committee working on logisitics. This includes food, medications, supplies, and the distribution of same. I believe they are also responsible for major supplies like oxygen for the ATS, extra generators, tents,etc. This committee was formed a couple of months ago and is also working with the Emergency Management people. They are supposed to give a report next month.
Where will the hospitals obtain the food, linens, medicines, IV’s ect. after their supplies run out?
There will be a supply that is stocked (and rotated) for most of the above. We actually already have some medications in a lock box for bio-terriorism. Although I do not know which medications.
Other Medications are definitly going to be a problem. You know, the BP meds, insulin, Etc. (Especially if supply lines break down anywhere between here and where that 80% of raw ingredients to make the meds are from. (Olsterholm, Testimony before the Council of Foreign Relations Dec 2005).
Certain IV Fluids will be in short supply, no matter what. Certain IV antibiotics will be in short supply no matter what. At any given time even now, there are backorders for certain medications and antibiotics.
My thought is…. In a pandemic, antibiotics will be nationalized.
Linens should not be too big an issue, as we can stock hundreds, and then continue washing them. (We do have a generator).
With the hospitals compleyely full where will the staff sleep, if the stay over?
When we planned for the surge capacity, we tried to look at several things. Patient flow, and ease of taking care of patients; Making sure part of the hospital is totally isolated. i.e. half the ED, all of OB, part of the OR. We also looked at ventillation. We did not want to put patients where the air would be recylced into our clean areas. We have areas that are separate from the actual hospital. i.e. outlying buildings, etc. Where staff can stay. There are also, many other options within walking distance to the hospital if necessary.
In our state the fire dept. has to go out on every EMT. call and vive versa. Wouldn”t the fire fighters be exposed with the EMT’s?
This is actually a little more complicated. Depending on the type of call, yes the fire fighters would go out with the EMT’s. But, this does not have to happen in times of a pandemic. There is another role for the firefighters, (because they also have some medical training.) They will also have access to phone banks, and will be helping to provide home care support. I am not real sure on the details of that, just what I have heard in the meetings.
Thank you!!! I do not mean to sound controversial, I am trying to get info. on many different plans. Trying to see what plans or parts of plans we can use here.
HEY!!! How about MY question? (Question: Who thinks you’re Crazy?)
:) I know you do not mean to sound controversial.
Are you working on a hospital plan or a county or regional plan?
Floridagirl
My husband thinks I am crazy because I Have purchased so much of everything. I am a RN and have mostly been getting a LOT of medicine and medical stuff, when I recieved a foot operated suction machine last week, he said I had really gone off the deep end!!!
Working on county plan.
Have you gotten in touch with state nurses registry and recieved names of retired nurses. There are hunndreds in florida that would be a great resource.
He thinks I’m crazy too – at 14:41
Let’s talk…
Email me at Floridagirl@singtomeohmuse dot com
If you do not want to use your own email, I can ask Dude to set up an email account on singtomeohmuse…
As far as medications… I have been told to not get rid of any expired meds… (unless it is nitro, has changed color, or if it is something where time really matters.)
BTW… You’re not crazy… :)
will close due to Forum speed. Restart a new thread if needed.