Forum: IM Very Ashamed to Admit This But

I have thought a great deal about this possible near future pandemic. I have been studying everything I can find related to H5N1. I have begun preparations as I think that the only way to truely avoid being infected (in a pandemic) is to self quarantine. Now, my problem (and guilt) comes from the fact that I am a registered nurse. I have thought long and hard about what I will do when/if this strikes. Yes, I have an obligation to take care of the ill…..but how horrible of a person am I for knowing that ultimately MY FAMILY, my 2 babies ages 2 and 5, are my ultimate concern and responsibility. NOthing else in the world is more important, to me, than them. I do not know how on Earth I would be able to go into work knowing that there is a good chance that I will be infected, expose them, or be quarantined there…unable to take care of my babies. I am having major issues with this and have been wanting to post, I haven’t seen any other posts similar (health care workers) Also what are the legal ramifications of me not going? Ugghh! I hate this whole thing but like I said, my babies are the ONLY thing that matters to me. Go ahead, I’m ready for the flaming lol!!

Take care of your babies :)

Seems to me there is a huge number of people who are going to be in exactly the same situation as you. The only thing I can suggest is to decide ahead of time what you’ll do, and if you’re going to stay home with them (sounds to me like you will and should) that you need to let people know ahead of time. Fair’s fair.

Let your elders try to be heroes. Stay home.

You can’t sacrifice your babies! They must have that one person, that will place them first! That’s what mothers do! Do what you can to help people now, plan, prepare, teach basic hygine, write letters! Then protect your babies, at whatever cost!

There are plenty of people who aren’t parents who can risk themselves…you can’t. Take care of your children. Stay Home

I think parents of young children owe it to their children to do whatever it is you have to do, especially in the case of single parent families.

You were Blessed with those children and Blessed with the responsibility of those children.

I have five children and my husband works with the public a good deal. He is legally bound to do so but he says that he will do nothing to jeopardize our kids. If he cannot find a way to work and avoid doing this then he will send us away or take the consequences of leaving come of the people to fend for themselves.

It is a difficult choice and I sympathize with you.

As a mother, your fist duty is to your children. Period. There will be other nurses who do not have little ones who will take care of the ill. Also, some retired nurses, medics, and others with medical knowledge will help.

I know some nurses or doctors will not report for duty simply because of fear, not because they need to take care of little children. Every person must make his own decision and live with it.

Your case is different. Your duty to your children comes before the duty to help others. Also, all of our children are our future. We must protect them first at all cost. You are doing what is right, and you really know it. You are a kind person, and you are troubled knowing that many people will be ill. Others will be there for the sick.

Perhaps there is some way for you to help answer medical questions on you computer at home during the pandemic. You could let some in your community know your e-mail address in case they had questions. Also, only after you have let your employer know you will not be coming in, you could offer to help answer some medical questions sent by e-mail to the hospital (which they could forward to you). Every medical center will be overloaded with questions.

When you became a mother, your first and ultimate concern became your children. That is still the case. That is as it should be. You are not selfish. If someone would think so, his priorities would not be appropriate IMHO.

I am with everyone else. STAY HOME WITH YOUR BABIES! You should never be criticized for wanting to protection your children above all else.

Society will be better off if you can all avoid contagion, and you can raise your own children, rather than they lose you, or you them.

If it is so bad that numbers overwhelm, and supplies run out I don’t understand what use a hospitalful of people with no way to help the sick or dying would be, anyway. We don’t expect firefighters to put out wildfires with their bare hands.

Decentralize this thing; don’t put Superdomes in every town, come pandemic.

Educating the public to prepare for supply disruption, teach them how to limit contagion, make provisions for how the fianacial/economy side will be run (fun times in the legislature -not!)get some basic home nursing skills, water disinfection, safe cooking and heating in power outtage info out there now, seems the only solution.

We can’t buy our way out, if pandemic turns out worse than 1918, by saying we’ll put more ventilators and vaccines and anti-virals on our national credit card. That’s not possible, not going to solve the problems and consequences. And we aren’t willing to pay enough staff as it is now; those with family commitments can’t be expected to sacrifice themselves or their families. We’ll need trained experienced HCWs post-pandemic!

Telling the public (and the corporate lobbyists?) tough; they’ll just have to get more frugal with their finances, prepare to sacrifice and have some hard times instead of mindless entertainment, work to learn how to take care of themselves, because taxpayers or no, there are too many of us to help, and we’ll all be affected.

We have to learn to look out for ourselves better. Tell the public, and the bubble-, or non-essential-sectors of the economy, better you sacrifice some comfort now, than we lose all our skilled medical professionals in a pandemic.

I could never fault the parent of young children for making them their first priority. That is how it should be. Take care of your children and DO NOT feel guilty about it. They will need you during the pandemic. Your employer will need you after, because surely there will be some medical staff who do not survive. You will be there trained, ready and hopefully still healthy.

I want to sincerely thank you all for making me feel so much better about all of this. I have struggled with my feelings for a long while now. I know in my heart where I belong. The only hero I need to be is in my children’s eyes. I appreciate all of your kind words and I feel much better. Now, I can choose to look at it in a different light. I am the ultimate protector of my children BUT I will also be around to perform my duty as a nurse AFTER we all survive this!

Also wanted to add…I hope I will still be allowed to work as a nurse when this is all over with. I’m worried that they could yank my license for refusing to work during a pandemic???

Meanwhile, stick every fork you have in Washington to get the FDA vaccine development protocol scrapped and replaced with something more pertinent to current events.

With everybody vaccinated beforehand, your dilemma, most all of our dilemmas, are resolved.

Remember in just a few hours of (if) HPH5N1 H-H, hospitals will close their doors. There is not going to be anyone who can lay blame on those who seek to care for family in a time of horror and social disruption. My guess is 2,400,000 deaths in the US. B-B B-H H5N1 will be in this country in 6 to 10 months. Some number of human deaths will follow. You might be of service in that time. BUT, when it goes to efficient H-H and if it has a high mortality rate, the last thing we need is healthy people bringing their sick to the filled acres of people surrounding a hospital and those inside making sacrifices with no hope. Your children will need you more. Just make sure you have plenty of capacity to protect yourself at your job and clean up before you go home. If things start getting too ragged, don’t go. Prep for 3 months at home and decide when enough is enough. And thank you for doing the job that you do. We are not worthy. I have a feeling that the human race is going to be living with this nightmare in our future for a long time. We will need people with moral fiber, decency, and sense of duty in that future. I hope to see you there and meet your kids.

I am struggling with the issue too. Assuming it is a very deadly pandemic, I think I might ask for a leave of absence or take extended sick leave for “personal reasons” as soon as it goes H2H anywhwere in the world. After the pandemic subsides, your employer will forget the “accident” that saved you and will want you back as experienced staff.

It’s the only way I can figure to survive and keep our jobs at the same time. You have to take leave before everyone else realises the situation.

Anonymous, I don’t know how the licensing thing works for nurses. I know that many police officers were fired for not reporting for duty in NO during the Katrina disaster. If you had your license on the line, I would continue working as long as you felt safe all the while keeping an eye open for another position outside of nursing and taking it so that you wouldn’t feel your career was being jeopardized for not going to work. Essentially, keeping your license in good standing, just not in use during the pandemic period and the waves following. You would not be employed with a hospital so you wouldn’t be called into action or onto the carpet for not going into work. Just a thought.

Your first responsibility is to yourself and then to your children. If you don’t take care of yourself, how would you be able to take care of your children?

Anonymous, I, too have been struggling with this issue. I am a nursing student (will graduate in a few months) with teenagers at home, and believe me, they need me just as much the younger ones do, but in different ways. What I am afraid of is that our government will institute some sort of “compulsory service” facet of martial law. My name and address are on file at my university - they know where to find me if I decide to take a “leave of absence” when this goes H2H. What do we do if our skills single us out - can we be forced to abandon our families?

anonymous and Kmc,

This is going to be the toughest thing about this pandemic. Whether people who are `essential’ report for work or not. And honestly, I have very mixed feelings about this.

First, I think any single parent should be exempt, no matter what. In families with two parents, at least one should be able to stay home.

And if hospitals or other workplaces are unable to provide reasonable protections (Tamiflu, masks, gloves, gowns, etc.), then no one can be expected to report for work. You wouldn’t expect a firefighter to rush into a burning building without bunker gear, so you can’t expect essential workers to face pandemic flu without reasonable protections. It would be fluicidal.

I’m hoping that older people, such as myself, will step up to the plate and replace younger workers. Our kids are grown. And frankly, if we get sick, we are less likely to die from a cytokine storm.

Hospitals, IMHO, will look like the Superdome 5 days after Katrina once a pandemic hits. They will be no place for a sick person. I also expect them to become flashpoints for violence, once they start turning people away. The appropriate place to care for someone with the flu is in the home.

If we allow flu patients to overrun our hospitals, then the medical system will crash, and no one will get care. It is a very cold equation.

But we do have a major problem if these protections are not afforded, and they go way beyond simply the flu. How well we come out of a pandemic will depend in large part on whether we keep essential services running.

Imagine what happens if utility workers decide not to work, and the power, water, and sewer treatment plants fail. What will happen if garbage (and body) collection halts. And what will happen if police, fire, and correctional officers abandon their jobs.

I honestly don’t see how we solve this one. If the CFR of this disease remains high, then few of these workers are likely to show up. And I can’t blame them.

But imagine every prison and jail abandoned by their staff, everyone from correctional officers to those that work in the kitchen. Food deliveries halt. Somewhere, a judge is going to decide very early on, that this will violate their rights (cruel & unusual punishment), and will order their release. A couple of million hardened criminals, all hungry and desperate, will be unleashed on society.

If firefighters decide, because the hospitals are closed and no one will be there to treat them if they are injured, to simply walk away. Fires that could have been easily extinguished may turn into firestorms. A lot of people will be burned out of their home, left with no supplies, and forced into the street. All it takes is one house fire, some wind, and no response from the fire department. Imagine if no one was fighting the brush fire in California right now. It would not be contained, and thousands of homes would burn.

If the power grid fails because workers don’t report, the misery factor goes up 10x for everyone. City sewers, btw, depend on electricity. Lift stations move waste uphill to treatment plants. Without power, within days, the neighborhood collection basins will overflow and millions of toilets will backup. The potential for additional disease goes way up. Think typhoid, dysentery, cholera.

The domino effect of all of this is what keeps me up at night. And no, I don’t have a solution.

I’m hoping the CFR drops, and at least some people will feel they can do the essential jobs that keep society from crumbling. Otherwise, the ramifications of all of this are going to be much, much worse than we imagine.

I don’t expect you, or anyone else, to recklessly endanger your families. There are limits to what we can reasonably expect people to do.

But I do hope that there will be some of us, particularly those who do not have children at home, who will step up and try to keep things on the track.

Otherwise, in the words of Olsterholm, we’re screwed.

Yeah, I’m 61. I hope there’s something us older frats can do so that fewer “kids” end up “going home” early. There needs some sort of planning for that.

ssal,

I’d like to see some planning for that. Sadly, I don’t.

I’ve seen this in several situations, from doctors with elementary age children who have to chose between staying away from their family in a semi rural situation, to young nurses with very young children. The issues range from family safety (from looters/’foodfinders’) to providing for the needs and comforting of preschool children without infecting them. I know of medical professionals who will not be willing to forgo the above, especially for those who refuse to prepare.

anonymous and Kmc - I too would hope that you put family first, stay home and take care of your babies / kids. Being 57 I agree with FLA-Medic - let us more mature folks (read as older) offer our services and ensure that the young Moms & Dads can take care of their families and to hell with what the government may or may not say. Know that even being older we also have wives, sons / daughters and if lucky like myself – grandchildren so even for us it is no easy decision as once we commit then we loose any chance to rejoin our families until this blows over - but with a good family planning and support I know that my own can and will make it through even if I am out of the picture.

If this issue really does become a reality, and it is looking more so every day, then it will be very, very BAD – with almost every aspect of our so-called “civilized society” breaking down. I feel that this will be especially true in our cities where no one or anything will be either safe or secure, this most definitely will include all our medical facilities which will become magnets for all the bad things (bugs and people) that our cities have to offer.

Bottom line - Your babies need you – and you need them… Stay Home and give them all the love and protection you can.

Lots of different reactions I’ve heard. Some will ‘go to work’ for a month and not come home so as not to bring anything woth them. Some will not report. Some will care for their street or block and that’s it.

The Canadians have studied this with SARS. See #3 in this essay. And note this isn’t the definitive answer… there is none. But anyoine doing planning has to understand that if family members of health care workers are ill or threadened, there’s not going to be 100% attendance at work.

I think everyone should read this essay. Totonto labored to write it, and it’s not the last word. But you’re not alone in struggling with this question.

Along this line…I have been in regular contact with my counties envioronmental health services woman for about 5 phone calls over the last 1 and 1/2 months…She has asked me to join our local emergency planning committee which I plan to do at thier next meeting next week…Now she has asked me to get a cert.(certified emergency response team)training…I am reluctant to do it for fear of being put on some essential workers list…what do you all think…I did make it clear to her my position of my children being my priority and our plan to self quarentine and she is fine with that.I only wonder if this would make me essential in some other realm other than locally…

anonymous – at 23:39 I support your conclusion, and asssume it’ll be an at-the-time decision based on best available data. What if, for example, the Canadian concept of reciprocity applies and you are given tamiflu for prophylaxis?

And here’s a hard one for everyone else. Should there be limited stockpiles of tamiflu (and there will be), should anonymous get it so she can work? Is that the greater community use, rather than individual stockpiling? That’s what some states mean when they warn you off of individual stockpiling with limited amounts available. And that’s precisely why we put an ethics section on the wiki.

These things really ought to be discussed in advance.

malachi – at 08:14 in CT such lists are considered strictly volunteer.

One last point… I am not suggesting my contrary posts are the ‘right’ answer. I am playing devil’s advocate. But I congratulate this community for getting beyond superfical yelling at WHO and gewtting to the heart of the matter. These are deep questions that every community will have to tackle.

We don’t have all the answers. But by asking the questions, and sharing such well thought responses, we’re growing up as a community. anonymous – at 23:39, I’m not ashamed of you, I’m proud of you.

I agree with the sentiments expressed here both for doing the community thing but more so for doing the right thing by your family.

Family must always come first. I hear much talk about our “civilized society” and would argue that our society is in fact not so civilized at all. If you mean we have technology and science and organised transport then fair enough. To me that is Tech advanced society but not what I would call Civilized.

Anonymous stay at home when things get bad. There is nothing to be gained from going to work in such circumstances. As far as the comment about Martial Law is concerned it will be imposed rather quickly I fear. This will happen because the Goverment will quickly loose control. The Government may aslo make it mandatory for first responders to go in to work with arrests being made for those who dont. My advice for you in a situation like this is to say yes yes ofcourse you are right. Then if there is any hint that they will enforce such measures get out fast. Dont look back. Simply disapear.

We have talked a great deal about how to cope with this looming disaster but as I have hinted and said before our biggest threat may actually be the Governments themselves. They will not hesitate to sacrifice large swathes of the population to maintain control.

This is why as well as isolating and having food stocks etc you should all have a bug out plan ready to action if it gets bad enough. NEVER PUT YOUR FAMILYS NEEDS LAST.

The Governments and the populations in general have been already warned of this coming disaster. You owe no one anything least of all the government. Take care of your own and ride this thing out the best you can.

Remember also how valuable you will be in getting our societies back on track after it all blows over so take the long term view. Plan to survive and keep your family surviving. Society will recover at some point although things may never be complety the same again. Thats maby not such a bad thing in my opinion as much change is needed.

In this case Number 1 priority is you and your family.

Another thing to keep in mind is that while anonymous may get support here at Flu Wiki, there will not be unanimous support where she works. That’ll be something to consider in terms of how to deal.

Trade-offs may be helpful. As an example, maybe anonymous can volunteer to do some day care for others who will go to work but refuse to come home. Both families benefit, and anonymous contributes, while protecting more than her own.

I understand that many of my suggestions will seem cruel and heartless, or at least unemotional. I promise you, it’s not the case. But thinking through what to do now is far better than trying to do it later.

Keep the principle of reciprocity in mind. Trade-offs are inevitable. Make sure you’re comfortable with whatever you do.

I am amazed at people who think others have an obligation to work during a pandemic. If a person makes that choice fine. A pandemic is bad…its really, really bad. Whether people go to work or not, it still will be really, really bad. What people are saying when they expect others to work is that we can control the severity of this. Nope, sorry but that is what makes pandemics bad. I do know its up to me to survive. I know that my house might burn down because there may not be firefighters. I know there may not be food. I know there may not be water. I know there will not be healthcare.

I am not saying don’t worry about others…no that’s wrong. Help them when and where you can, but always keep your family first.

I have a small one and know that the hospitals will not be working in short order and it’s scary knowing that help will not be available but I know pandemics are really, really bad.

If this outbreak is big, none of us here, expect there to be critical hospital care. There won’t be enough pressurized ventilators around. You have to be prepared to lose your income until a surefire vaccine can be given to healthcare providers. You may be able to give nursing advice to your community, in other ways. I would like to learn how to put an IV. in, for fluids, for example. I have one son who gets dehydrated and has needed that, for viruses. Can a private person buy IV. supplies?

I believe that the post which began this thread may serve as an indicator of the level of dedication, self-sacrifice and commitment that we might expect to see from our health care workers. This may be what differentiates the West from China when the second shoe drops.

It might be best for society if you (and others like you) make your decision in advance and leave your position early so that emergency planners will have a realistic idea of the true work force and so will be better able to make alternative arrangements.

But if you choose to stay in your position until we’re up against the wall, do you plan to take advantage of the government’s plan to provide health care workers and their families with the prioritized first doses of available vaccinations and anti-virals, or will you step aside and allow legitimate health care workers or those who are more in need to receive it first?

unique – at 09:07 you have to understand that health care workers are the ones who put the obligation on themselves. They’ve always been unrecognized heroes.

My first response to your question, would be “heck no, I want the vaccine” as I’m sure everyone’s would be…but I realize that if I’m stepping aside and not serving on the “front lines” than I must give up my right to be vaccinated as a healthcare worker. Tough decision.

To ask professional people to consider leaving their job and loosing their income just when they need every penny to prepare foodstocks and protect their families is the kind of Logic I would expect from someone in government.

To further use language that makes them out to be hypocritical if they remain and take advantage of antiviral medication is cruel.

Why dont you ask similar questions of those in Government who will be given top priority to antiviral medication. I think I know who is more valuable and its not those sitting at desks but the hard working health care professionals we depend on so much.

The plans that you refer to should already be accurate enough to take into account percentages of people who will not go to work.

I throw in my vote to take care of your babies first and foremost. I think alot of the responses talked about other ways that you can help from home. Just having you answer “laymans” basic health and medical care questions on this blog is MOST helpful. Alot of us have no idea how to care for someone with the flu or for a loved one who cut themselves or any other medical emergency. You could be a huge service to us and to your community by speaking with someone on the phone or responding to an e-mail about care. Invaluable service and it would still keep you at home taking care of young children who need you desperately. Maybe you could type up some basic guidelines and distribute to your neighbors or at your kids nursery school.

I recently saw a show where two elderly men were remembering the Spanish Flu of 1918. They were asked how they survived it. They answered that is was due to their Mother who would not let them leave the yard! We need Moms and Dads to keep their kids safe and to help prevent further spread.

The one thing that strikes me is that the comments in this thread match up with management training I have had in the past. It is obvious that you cannot intimidate people into doing what they fear to do or feel is against their self interest. My own policy, for example, is that my deductible is more than a day’s pay, and since the Company has previously screwed me over on a snow day issue, I know where I stay in inclement weather.

The way to get people to do what needs to be done is to lead them. A credible, inspired leader with a vision and the ability to communicate it can get people to perform under the most arduous circumstances. Look at Shackelton and how he not only got his crew to survive, but almost single handedly went and got help for them. When he was safe, he went Back Out to make sure they were all picked up. Look at the Soviet helicopter pilots who sacrificed everything to regain control of the Chernobyl situation.

This is all about leadership, or lack of it. As soon as I am presented with a credible, charismatic leader with a vision I can follow, I’ll be right out there with him. Otherwise, eh.

Devils Advocate – at 09:53

These are real life dilemmas. The idea that tough questions shouldn’t be asked or possiblilities and choices shouldn’t be presented and weighed because they sound vaguely ‘goernmental’ makes little sense to me. Every possibility and option should be on the table in advance.

A ‘governmental’ response would be ‘see manual 7 chapter 5′ which turns out to be the 1994 snow day policy and is both unreadable and inapplicable.

Devils Advocate – at 09:53

These are real life dilemmas. The idea that tough questions shouldn’t be asked or possiblilities and choices shouldn’t be presented and weighed because they sound vaguely ‘goernmental’ makes little sense to me. Every possibility and option should be on the table in advance.

A ‘governmental’ response would be ‘see manual 7 chapter 5′ which turns out to be the 1994 snow day policy and is both unreadable and inapplicable.

DemFromCT – at 09:52

An obligation is not an oath. Obligations can waxe and wane as the situation permits.

As far as unrecognized heroes, truly nurses are the unrecognized heroes in the healthcare field.

Oaths are pledged at graduation and pinning ceremonies, actually. Some people take them at face value.

See oath

http://www.hhs.gov/nvpo/pandemics/tabletopex.html

In this HHS tabletop exercise, they estimate that 30–40% of a hospitals staff are going to be out due to illness, caring for loved ones who are sick, or from fear. Are you saying that this estimate is way too low? If all parents of kids under say; 13, felt this way, this could easily represent 30% of a hospitals workforce alone. Is the HHS just fooling themselves?

Face Value? I guess the oath is as good as who they pledge to?

“I swear by Apollo, the physician, and Æsculapius and Health,1 and All-heal,2 and all the gods and goddesses, that according to my ability and judgment, I will keep this oath…”

My own thinking on this issue has changed somewhat over the past few weeks. At first, I was surprised and disappointed at the number of health care workers who are contemplating not going into work. But I’ve been grappling with this issue almost non-stop for days, and my opinion has moderated.

As a former paramedic, I can tell you that it never would have occured to me, or any of the men and women I worked with, to abandon our posts in the face of a crisis. We talked about this a lot during the run up to the `swine flu’ pandemic, and I don’t recall anyone saying they’d stay home. Bravado? Perhaps, but I think it was genuine.

But that was 30 years ago. Times change. And no one considered swine flu to have a possible CFR like we’re looking at with Avian flu.

I’m sure, even then, some doctors and nurses, paramedics, and cops would bail to save their own skin. Not many, but a few. More might because they would fear bringing the virus home to their families. It’s one thing to risk your own life, another to risk your family.

But the real killer here is the fact that every hospital will be quickly overrun by flu victims, and that medical care will grind to a halt.

Hospitals routinely run 80% to 90% occupancy. They have little surge capacity. A 600 bed hospital might be able to accomodate an influx of 100 flu patients, but after that, they’d be at capacity. Vents will be in short supply. Frankly, there will be little that they can do for flu patients that couldn’t be done better at home.

We seriously need to consider whether flu victims should be treated at or admitted to hospitals at all. Perhaps some hospitals should remain `flu-free’ zones, so as not to cross infect patients. Nosocomial infections are already a major problem, introducing a highly pathogenic flu into the mix will only endanger the staff and patients.

Radical? Perhaps, but it needs to be seriously considered. Nothing will be gained by destroying the hospitals, and there are plenty of non-flu patients to consider.

Perhaps flu-centers can be set up in high school gynasiums, where volunteers can tend to flu victims. Or one hospital in a community can be designated a flu receiving center. But if we simply allow all hospitals to fill up with flu patients, all we will accomplish is to destroy that facility.

In the face of the likely destruction of any cohesive medical care, how smart is it for medical personnel to go down with the ship?

Two weeks ago, I looked at this as a black and white issue. Today, I see miles of grey.

I still believe in duty, and honor, and stepping up to serve in a crisis. Easy for me, I’m divorced and my kids are grown. I can make a sacrifice if need be. But for those with kids, this will be a terrible decision.

There are no easy answers. I certainly don’t have any. But I am far more understanding of the predicament that those in essential jobs will face today, than I was a few weeks ago.

Affirmative.

(They are just hoping it won’t be very virulent at all.) I wish they’d tell the public “pandemics are really, really, bad” and tell them how to prepare at home and to do it now, because if households aren’t prepared nothing else they want to function will work.

I realize that Hollywood movies and heroes, as depicted in the past, were mostly propaganda and that in this day and age we don’t see the world through rose colored glasses.

But just imagine the twists and turns an old 1940′s era movie might take in the epic of Florence Nightingale leaving her post when the going gets rough (but grabbing a vial of vaccine for herself and her family on the way out the door).

I wonder how this movie might conclude, what would be the moral of the story? How could they convolute this course of action into a happy ending?

(Oops; “affirmative” officials are fooling themselves, or at least tippytoeing around the public.)

“according to my ability and judgment, I will keep this oath…”

Well, ability and judgement, in an ‘only gets this bad about once in 100 years, very-contagious/deadly global event”, is different than the tough times we get mostly.

I also have the same reservations about schools/gymnasiums being used instead of hospitals, if there are not things available to care for the sick with, nor people with enough protective gear, whose families don’t need them. It needs to get presented to the public for discussion, and the vaccine priorities need to be imporved, if there ever was some health care and essential utilities/services people need to be before even vulnerble general public. (And I think general public needs to be ahead of criminals for resources, but, that’s another can of worms.)

Hey, since imaging research indicates brain maturity and good judgement comes as late as 21 to 25, in some, I can see why the parents of teens feel society still needs their parents trying to raise them.

Fla_Medic – at 10:30

Good points but I question:

“Perhaps some hospitals should remain `flu-free’ zones, so as not to cross infect patients.”

Do you know what the probability of remaining flu-free would be in a pandemic? We will have no control over this. I accept this without dispair and plan accordingly. We humans and especially we Americans like to belive we can control everything. Fear of losing control drives many people.

Fla_medic (and others) - As I read this and other threads, I see alot of “we shoulds”, “we’re gonna have to’s”, “when the time comes”, and “we hope they’ll do such and suches”.

The only thing table top exercises seem to have taught anyone is how to be more reactive. There is no evidence that I can see, thus far, that any pro-active changes in how things are done are being implemented.

Thus, as of now, I predict that all hospitals will be over-run and shut down because no other plan to the contrary has been announced. Caregivers will not be given special treatment because no such plan is in place now. On the day H5N1 flies into this country (could be this afternoon, for all I know) in a human compatible form, the airport personnel will have no prophylactic Tamiflu for themselves, nor especially for their families, because there is none now. The only option that caregivers will have is show up or be fired or imprisoned, because that is what we have right now. Businesses will have no plans in place to act differently than their current methods of operation, because they are not in place right now.

I do not believe in magical thinking or Just-in-Time management. Governments and corporations are immense creatures with huge startup transient times and with many entrenched self interests who battle any change at all under any circumstance.

I will await to be pleasantly surprised to see how wrong my views are When The Time Comes, but as of right now, the starter’s pistol could fire at any instant, and based on what is out there right now, we have the equivalent of our shoe laces tied together as soon as the race starts.

I saw doctors talk the talk when AIDS first showed up, then literally ran when they were splashed during procedures on an AIDS patients, leaving the patient in the care of…nurses. A huge nursing shortage occured during the 80′s with the advent of AIDS, as well as other career opportunites for women. Because our salries rose-alot-men came into the field, as now they could actually support a family. (In NJ at that time there was a signficant construction slump.)Some of us just stuck it out.

Fear will keep some staff home, as will comittments to family/children. If hospitals make arrangements for nurses to show up, it’ll be the first time ever; to most institutions we are just a commodity, names to fill in the blanks on scheduling forms. How many nurse managers will show up and do direct patient care? They will be demanding this of their staff, but likely not too willing to actually do the care themselves. Some good, dedicated souls will, but not many.

Many good questions raised here, I say plan for the worst, hope for the best. Off-site medical care facilities will need to be provided, perhaps flu-sepcific hospitals.

Fla-Med,

One update: our hospitals are already working at 96–98% of capacity. There is much less space than you imagine.

“Gee, I really want to be down there on the floor with you people under these circumstances. But there’s a mountain of paperwork that I need to get done up in my office first. Call me on the phone once in a while and let me know how things are going.”

As a mother of 3 children I certainly agree that your responsibilty is to your children; to isolate them and care for should be your only concern. Those of us with older/grown children might choose to put our health at risk, but I’m sure anyone would agree that you owe it to your children to do your best to stay healthy. After all they are our future. Unfortunately I don’t think our state or local governments have even begun to address these issues. In the event of a pandemic, Licensure could be an issue for health care professionals. The Turning Point Model Statute Public Health Act in section 6–104(d) requires cooperation during a pandemic as a condition of Licensure. This is only a RECOMMENDED set of laws for the states and unless your state has adopted it or something similiar there is no problem. You can find it at this web site for The Center of Law and Public Health. It is interesting to read as it covers other issues as well. http://www.publichealthlaw.net/Resources/Modellaws.htm#TP They also include a list of states that have adopted parts of this along with what sections they adopted. Some states may have had section similiar to this already, so you would have to research your own state to be sure But I find it hard to believe that any state has the luxury today, with so many shortages in the medical fields, that they could deny license renewal to hundreds of nurses and doctors who choose to protect their own children. Something that might be a bigger issue is being caught at the hospital if a quartine order is issued by the state/county health department for that facility. A friend of mine has confided that she assumes this will be the case with her physician husband. It will be up to her to protect the children. Hopefully there will be some advanced warning that this could occur. Providing medical help over the telephone or email during a pandemic is probably a very realistic option. I can’t imagine it will be many days into a community outbreak before public service announcements are directing families to stay away from the overcrowded hospitals and call an 800 number for help and advice. I think most of us here realize we could be on our own caring for a family member. I can only pray I would be able to reach someone like you by phone.

Eccles: There are companies,esp large finacial ones, that have started making plans to stay alive. I hope that plans are in place to protect some healthcare and research related workers because if not you will not get that vaccine that everyone hopes for! The issue of coming to work in a pandemic has come up in my conversations with staff RNs at our hospital. I have faculitated discussion and printed docs off of the flu wiki for them. Awareness is seeping upward to administration. Our IC RN has been tireless in pushing pandemic education every time she can. I have given one Grand Rounds presentation and will have another inservice next week. I may or may not come to work when avian flu arrives. I am a long term type one diabetic. I had one our physicians tel me that I should “stay the hell away from this place if this hits because if you get this you are going to die” Well, maybe. I am a Nurse Practitioner and they will need me. But they will need me afterwards also.So I will make that judgement in consultation with my god and my wife.

In the for what its worth column: A fellow named Terman conducted a longitudinal study of gifted (genius) level people. They did all the things you would expect. At the end of their lives these people were asked, “What is it all about?” Nearly all of them said that first you have to be well connected to your family, then you can make the world a better place. So there you go. I think it applies across the board.

BTHW these 200+ people also said that this was the single most important idea in anyone’s life.

Just my two cents - there will be a dire need for trained and fully functional nurses, EMTs, etc after this if over - that is when your real worth will come into play - but you have to be alive to pick up the pieces and render the assistance that will be needed after this is over.

I am more than willing to help all I can during (good idea with phone calls, helping here, etc.) makes me feel at least like I’m doing something for the community. I will be the first to be out there helping once it is all over with, again that’s assuming I will still be allowed to be licensed as a nurse. Big issues I wish they would deal with now!

Eccles- re: “Gee, I really want to be down there on the floor with you people under these circumstances. But there’s a mountain of paperwork that I need to get done up in my office first. Call me on the phone once in a while and let me know how things are going.”

You got it absolutely right, that’s just about word for word what I have been told so many times it’s not funny…..

I remember just 2 years ago we were visiting in Shreveport, LA and there were city hospitals closing their doors and rerouting ambulances because they were inundated with flu patients. They were even rerouting gun shot victims. And this wasn’t a pandemic flu.

The wisdom of crowds. This is one of the best discussions we’ve ever had here. the trick is to balance what we can do with what’s likely to happen. In a pandemic all the planning in the world won’t stop hospitals from being inundated. The issue is too vast. So to then turn around and yell at the hospitals for being unprepared is futile. OTOH, one has to do some planning, something , ina dvance and that might incude ‘alternate care facilities’ like schools, while making sure the hospital isn’t counting on an area that the mayor has already designated a red cross shelter.

Hospitals are businesses and their HR depts have to adjust just like other businesses. And the other trick is balancing what’s best for the community vs what’s best for individuals.

Unique, all I’m trying to do is explain how seriously this obligation is taken, and how torn our original poster is. There’s nothing else to explain.

Eccles, the reason these things haven’t been done, and probably won’t be done, is a lack of foresight.

In every planning meeting there is at least one person who will explain why something can’t be done, and they will cite numerous budgetary and logistical constraints.

We need to find these people. Single them out. Seperate them from the herd.

And shoot them.

There won’t be such a thing as a flu free zone. People are contagious before obvious symptoms begin so how would that work?

My suggestion was to restrict flu patients to separate facilities, to allow hospitals to continue to care for heart attacks, strokes, & trauma.

No, you can’t keep the flu out of that hospital. But you can keep from taking in hundreds of flu patients that will compromise care for everyone else. If a patient exhibits flu symptoms after admission, you transfer them to a flu receiving facility.

Maybe it doesn’t work. Won’t know til you try. But if we allow all hospitals to simply be overrun with flu victims, all medical care will grind to a halt.

For many years we had TB sanitariums in this country. Separate hospitals for TB patients. Why? Because they are contagious, and to mix them in with regular patients was to risk cross infection.

Same idea.

Fla_Medic - There are two types of HR person that I have encountered in my life:

1. The guy who tells you why something that you thought was coming to you isn’t coming to you, despite what the rulebook syas in plain print. And despite clear printed policies that say it is coming to you.
2. the guy who will look for a way to get you what you need, despite the fact that there is no clear policy that says you SHOULD get it. He will go out of his way to make sure you are treated properly.

I think the fate of the planet now depends on the population distribution of these two types of HR people. Those companies and services which we need to keep things going will survive with type two, and sink (and us along with them) if they have type 1.

It has been my personal experience that the type 1s outnumber the type 2s by a lot. Woe is us.

DemFromCT – at 12:30

I do understand and appreciate your comments.

I’ve been finding that this whole pandemic situation is putting a lot of things into perspective for me. I’m having some issues at work lately (ie. boss giving me a hard time for who knows why) but when I stop and really think about it….it doesn’t even matter.

When it comes to the people you love being at risk and an entire human race being at risk by a microscopic bug, everything else just seems to trivial and silly to even bother worrying about.

A friend said to me two days ago “I just don’t want you to seeing you get so wrapped up in this doomsday stuff, and not enjoy your life today.”

I replied to him “On the contrary. I appreciate today more than I have any day, because I no longer know what darkness tommorrow will bring.”

I agree with Fla_Medic-keep the suspected flu patients in one facility.(no waiting a week for WHO test results). Try to keep everyone else in other facilties but heightened alert for fever symptoms among staff and patients. No visitors.

Problem is- there aren’t enough hospital beds open in America to do this. Perhaps take over a very large hotel….I don’t know anyplace that can do this fast, other than the military, to be honest.

There was a statement made at Michigan’s Pandemic Influenza planning meeting that really caught my attention, it was made by an Infectious Disease Control Practitioner from the St. Johns Medical facility. “In the event of a pandemic, hospitals will shut down normal activities”. No one seemed surprised by that statement, no one questioned what exactly that meant. Those of you who work in a hospital who are able to answer, what exactly does that mean?

It is a privilege and an honor to be part of this community of thoughtful resilient people, all trying to “imagine the real” in advance of a pandemic.

Forgive me for once again riding in on my favorite hobby horse: Early pandemic survivors are likely to be immune, at least during that wave. Those people can volunteer or be hired to fill some of the crucial positions that will put non-immune people at high risk.

With or without lab-verification that one has had the actual flu, many of us lucky enough to survive the first round will want to help others.

Flu survivors should be considered a significant component of “critical infrastructure.”

edited for redundency by request

Wow you really meant that statement didn’t you ? LOL

Jody,

I’ve signed up for the Medical Reserve Corps, even though I have no professional medical background. My purpose is to help out in my local neighborhood, which I am helping with awareness at the current time. I’ve also undertaken some CERT training.

I don’t plan on getting the flu, and frankly my involvement is primarily helping people understand how they can treat their family members at home. If both adults in a house are sick, however, then I’ll step in, especially if there are children involved.

EOD, elective surgery (hernias, shoulder and knee repairs, etc) might be stopped, well clinics might be coverted to sick clinics or the staff assigned elsewhere, the recovery rooms might be made over into ICUs etc.

In Toronto, the switch was turned off easily enough, but turning it on wasn’t so easy. Who goes first if everyone’s elective surgery is delayed three weeks?

Will, treating folks at home might be a major necessity. The expansion of ‘alternate care facilities’ would be for when that’s not enough.

Here’s an interesting study I found elsewhere on the wiki:

Health care workers’ ability and willingness to report to duty during catastrophic disasters.

anonymous 23:39- During our family preparation discussions this has come up. My brother-inlaw’s Mom is a health-care worker. She was a nurse in Toronto during the SARS ourbreak. She said that if her children had been young and still at home she would not have worked at that time unless someone else could care for them. The way she put it was that ‘nursing is my calling, but my children are my life’. She was able to work as her ‘kids’ were away at university. She says she cannot imagine hospitals can even hope to cope with pandemic influenza and her heart goes out to all of the parents that will be feeling guilty regardless of what choice they make.

My husband is a fire-fighter in our community and has EMT training, although not actively working on the ambulance right now. We have a plan to isolate (myself and the kids with extended family) and he will likely stay here to help as ‘essential services’. I don’t like that decision, but I do respect it. Part of what makes him who he is is his responsibility and compassion for others. This is a hard decision to make and there are many out there who are struggling with it. As a mother, my opinion is NOTHING is more important than your children. I feel that once you have children they come first regardless of circumstances or consequences involved.

As to finding work post-pandemic, many in the health care field will work during the crisis. Many of them will get sick and some of them will die. Trained and healthy nurses will be needed when the pandemic ends. I hope you find a solution that works for you.

I think that MaMa’s husband has it about right. The family has to be stashed and protected and that means safe. Obviously, one or more responsible and credible adults will have to be at home. After that, those in service occupations have to do their work (that is why it was chosen). I may have to talk to the family from the other side of a plastic sheet at the end of the day, but I also have to live with who I am and what I do.

It is for this reason, among others, that I want all of the family home. That may mean that we now have 20 people in a home that used to house far less.

JoeW, I think for those of us in emergency services (fire, EMS, LEOs), that is exactly how 90% will handle it.

It isn’t heroism, btw. It’s just how we are wired.

As with most questions, it’s about a risk benefit ratio, what are the risks, what are the benefits, and in this case, these are very personal.

We already know about the risks, enough said. All I have read so far shows all medical systems are likely to be overwhelmed early, adn quickly ineffectual, so I question the benefits in staying to help people who may not be able to be helped, when the supplies are all going to run out.

I think part of the point of all this prepping is that a hospital is the last place most of us want to be in a pandemic, and to suggest that others should do it when we won’t can be a bit disingenuous.

I think medical professionals (I am one) are willing to make many sacrifices, and do, we saw them on TV during Katrina, but I don’t think martyrdom is helpful to anyone. Nursing and medical skills will also be needed after the first wave (or second) or in between.

I think it is highly unlikely you will lose your license for not volunteering for a possible suicide mission (this isn’t the military, yet). But you might lose your job if you don’t go, but I’d suspect there would be plenty of openings elsewhere.

It is one thing to work in a fully equipped hospital caring for BF patients now. I would do it now. It’s entirely different to do it in a pandemic without adequate resources.

I think it is a choice we need to think through individually, with our own conscience. And I don’t think others are in a position to judge, unless they are willing to walk a mile in contaminated shoe booties.

Ok…..another health care provider’s viewpoint (Physician Assistant). I assumed risk as a medic and Physician Assistant in the military. Caring for comrades under fire is inherent in the job description..you know that risk/sign on the dotted line and willingly take it for your brothers. On the other hand…as a (now) civilian Physician Assistant, my job description does not assume that I will take risk for a rather potentially lethal illness. Yes……….I do work extremely long hours caring for my patients….but I do not feel obligated to subject my daughter to the loss of her father due to his feeling of “obligation”.

So anonymous – at 23:39….you ain’t alone…have no regret unless you feel you’re violating one of your own personal tenents.

For others….if the fan is blowing brown stuff…my viewpoint is not unique…yes some will assume that risk…but prepare for not that many if the situation is very dire.

I say go to work:

1) The influenza virus is spread via large particle droplets , which can be prevented with simple infection control precautions (i.e., PPE, hand hygiene, etc). Airborne transmission is theoretically possible but has never been demonstrated; N-95 masks are recommended during certain procedures, but not routinely. These standards are in place in every hospital in America. Training in and adherence to standard and droplet precautions can prevent transmission. You are not helpless!

2) Attack rates are estimated to be 15–35%, with 1–2% chance of severe illness. Many infections will be mild. Contracting the virus is not necessarily a death sentence!

Do what you have to do, but fatalism prevents positive action!

otherwise, see my link above to the NYC study. I think we need to recognize there are different povs, and that it isn’t (just) a matter of what’s right, it’s recognizing what will happen. There is no ‘one right way’ but if I were an HR VP or Chief of Nursing or medical staff chief, I’d be very aware of a thread like this, SARS experience, and previous published data, and plan accordingly.

DemFromCT-

Regarding the study of HCW about their willingness to show up…

We have to remember that what they SAY they will do might differ from what they will actually do if a pandemic shows up. Were they thinking about the fact that ALL schools and daycare places will be closed? The HCW may have good intentions of showing up, but I think the lack of childcare is the single thing that is going to keep large numbers of HCW from going to work.

Great discussion…thanks everyone. I struggle with my professional response to a pandemic. As a healthcare provider and medicial reserve corp member I maintain no one can be absolutely sure of what we’ll do until circumstances present themselves. I thought, I hoped, a decision would be so much easier than it may end up being when reality hits. I don’t have young children at home, so I’m a natural to go into work, right? But, but, BUT…I have young grandchildren, very young ones with parents the ages most vulnerable to the cytokine storms so worrisome with this flu. In a worst case scenario, I might be the one left to raise these children. Do I chance there being no one in the family left to be there for these precious little souls? It’s simply impossible to know at this point in time, IMHO.

opps, the previous post was mine. Sorry!

opps, the previous post was mine. Sorry!

I will say again this is one of the best discussions we’ve ever had here, and it’s interesting that the variety of opinions matches the formal study. I don’t have access to the full study. The abstract claims some of the ‘barriers may be overcome’. I wonder how.

“otherwise”, the for-profit hospitals have been refusing to stock up ahead of what the hospital will use in the short-term; it is not cost-effective to take their money out of the bank and buy PPE, ect, yet during a pandemic it would have been.

The change of severe illness rate you list are currently incorrect.

That was a wildly optimistic number picked for the Congressional Office Budget macroeconomic report on the probable effects of pandemic influenza; used the global average mortality for 1918, and there is no reason to do so now.

Currently the mortality rate for H5N1 is in the double digits and there is no reason it has to become less deadly to recombine a piece that will make it pandemic-level-contagious.

Hospitals are currently about full right now; going to make medical personnel lose a lot of patients once suplies run out (pain meds, other meds, stuff needed for surgery, blood, ect) staff like housekeeping won’t be safe to stay, and, they have families.

We were told to expect surges 4, 5, 6, times what hospitals normally handle; after the first day or two, we are back to 1918 medical conditions. Sheer numbers easliy overwhelm our “modern” system. The loss of life even from no Rx meds for a month, or no electricity for a month, would be greater than what the US government projects a “severe” pandemic would cause.

The public has to be told to try and get ready for that.

I wish hospital administrators and public-health types would read this thread, because obviously they need to do some careful planning and preparation for the fact that a.) hospitals will be overwhelmed early on, and b.) some sizable proportion of HCW will stay home, either out of necessity or choice.

It seems like the problem could be drastically reduced with some combination of flu-only facilities, in specific hospitals or schools or hotels or gyms, as Grace said; a system of telephone triage; some kind of online and/or telephone consulting for people caring for patients at home. The last two of these things could be handled by HCW like anonymous and others who are single parents, etc., and either can’t or don’t want to go in to work, but want to help somehow. And maybe a backup plan, in case of loss of telephone or Internet, for shortwave radio communication and regular AM/FM radio informational broadcasts.

If the people in charge were really on the ball, they’d put together “caring for your flu patient” guides now, and get them into every household’s mailbox: A list of medical supplies to buy, telephone numbers to call for assistance, symptoms to look for, how to provide care. Even offer “basic nursing care” classes up-front.

But that would be too much to hope for …

One final thing and I’ll shut up: I have a family who tends to get really sick and spend, oh, three, four, five months in the hospital, from ICU to rehab — and luckily, they get great care, from very professional, compassionate, dedicated health care workers (as I suspect you HCW are). They wouldn’t be here if they hadn’t. So, hats off to all of you.

Worried Well – at 10:29 All of those options have been discussed in the NZ, Ontario and various state plans, some are more fully formed than others. The ‘teaching’ of how to care for yourself at home a has also been discussed, including here with Dr. Woodson’s guide and elsewhere. The idea of phone triage and volunteers who won’t work in hospital but will work from home is a very good one.

Another is Dr. Jody Lanard’s piece way above about survivors being ‘deputized’ to fill in. legal barriers need to be addressed there, as well.

Yes, I also would have died without “modern medical care”, and am grateful that I can still try to do some good.

Worried Well – at 10:29

I wish hospital administrators and public-health types would read this thread

I’m going to add links in the wiki to this thread at various places, including workplace continutity and medical workers.

the flu only idea has some merit. But in thinking it through it becomes problematic. Say a off site building is used such as a school. How are you going to deliver O2? The likely hood of finding concentrators or tanks in enough quanity is scant- Where are you going to get the supplies needed to treat these people with even the bare basics. Again its not just bed space we are lacking its basic supplies. IV bags and sets O2 meds ect… without these basics your doing nothing more than wharehousing - what is the staff to do in these off site facilities? Wipe foreheads? Waste of human assests. These sites provide another place for the spread of infection, and you tie up [kill off] valuable medical personel. It is not places we are lacking its supplies. I keep hoping that somewhere somebody is stocking up these critical supplies Im afraid Im hoping in vain. All Ive seen is the Feds telling the States its your problem the States crying poor the hospitals barely a peep

Lets do this step by step. Im a nurse at one of these sites or at Ive just gotten a pt.. 1 first Im going to get thes pt on O2 say Ive got a tank from a welding supply ok [a] is there a regulator with it? [b] O2 tubing? [c] a cannula? Without any of these things I cant even give a basic comfort measure of O2.

2 Now on to a IV my second basic measure. Say ssomeone has jerry rigged a IV solution in a glass bottle [not likely but for arguements sake] Now I need to start that IV OOPS no sets to do that with, I also need tubing to deliver that IV with.

So now what do I have to offer this pt????

Almost all medical supplies are plastidc and disposable now. If even 5% of the puplic requires hospitalization all those supplies will be exausted. Where are replacements going to come from. Now some of you are familuar with hospitals central supply - how much surge capacity is sitting in any central supply in the US? Days hours??? Where is the rest going to come from????? We are talking 6 to 16 weeks for a wave with 30% infection rate? We are talking kicking the healthcare system back to the dark ages.

Janetn—This may sound cruel.

Martial Law Edict A-1

All prospective hospital/clinic patients will be assessed at curbside in their vehicles by teams of medical personnel and armed members of the National Guard. Those patients exhibiting clinical signs of pandemic flu will be told to go home and care for themselves and their own as best they can. If they refuse to go home, or if a patient is left at the facility, they will have the opportunity to briefly view the warehousing facilities in which they will reside, and the care that they will receive. They will be accompanied by an armed guard. At that point the prospective patient can choose whether to stay, leave, or call the people who left them to pick them up. If they are not picked up, they will be housed in the facility.

Med. Mav. - that is probably the most realistic prediction. What can a hospital administator really do with a shortage of nurses and doctors. Stocking up on more supplies, more oxygen, more beds, won’t help if he can’t pull more nurses out of a closet too.

I dont think its cruel, I think its realistic. The truth of the matter is that people will get far better kinder care in their own homes. Unless somewhere ther exists a medical supply fairy.

People dont seem to understand that its beds or space we are lacking its basic supplies. Ive heard people bemoan the lack of vents - frankly that wont even be a factor -the basics will.

Tell the public now what little care they can recieve if they fall ill, and perhaps they can be told what to do to prepare after that has sunk in.

Sounds about right, maven.

Triage. It’s never pretty. But you have to concentrate your efforts on what is salvagable. In this case, we aren’t talking at a patient level, we’re talking on a health care system level.

The best that a patient in a flu receiving center can expect is a cot, and someone to bring them rehydration fluids and a bedpan every once in a while. IV’s, Oxygen, suction, vents . . . luxuries not likely to be available after the first few days.

There are many people who live alone who might be forced to use `service’, but no one in their right mind would if they had any alternative. Dump jobs’ will be common, tho.

Sorry, but when it comes to pandemic flu, we’re pretty much back to the level of care in 1918. To try to do more will break the system for everyone.

Re: Dump Jobs- ie dropping off elderly/needy people/kids in ER’s and then running away..sometimes they’re just left in the parking lot in a wheelchair and is someone doesn’t find them they could have frozen to death…Ah yes the old “Pop-drop”…vacation time, need to do holiday shopping..excuses vary, outcomes the same..

This article was posted on Reuters today, and although I do believe morale is important, I think the article has missed the point that has been so well expressed on this thread: we HCW need to be assured that we are not going to place ourselves and our families in danger by coming to work. Period.

Medical staff morale key in bird flu outbreak: expert Sat Feb 11, 2006 2:01 AM ET

By Jennifer Tan

SINGAPORE (Reuters) - Hospitals must prepare their staff for the trauma of a bird flu epidemic or risk a collapse of morale and services at a time when they will be most needed, a medical expert said on Saturday. “I predict that you will have very few staff two weeks into the epidemic if you do not have mechanisms in place to minimize the stress and effect on morale,” Charles Gomersall, the director of intensive care at Hong Kong’s Princess Margaret Hospital, told a bird flu symposium in Singapore.

“If you have poor staff morale, they will not come to work, you would not have a service — end of story.”

He said hospitals could offer staff counseling and daily debriefings to help them manage stress during an outbreak.

While the H5N1 avian flu virus mostly affects birds, it has killed at least 88 people in seven countries since it re-emerged in late 2003, with most victims in east Asia.

There is no evidence yet that the virus has mutated to the point that it could spread from human to human, a nightmare scenario experts believe could kill millions.

Gomersall said there appeared to be a higher mortality rate among avian flu patients than among those affected by the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, particularly among children.

Taking 54 reported bird flu cases from Vietnam, Thailand, Hong Kong and China, he found that the death rate for those requiring intensive care was 89 percent and their median age was 12.5 years. “The much greater problem in avian flu compared to SARS is the high mortality, in particular the high mortality amongst children,” Gomersall said. “The family will have dropped off their child and the next time they see him, he will be dying — can you imagine the effect that will have on staff morale in your unit?”

Gomersall said hospitals needed to start equipping their facilities and training their staff now.

“Once the epidemic starts, you’ve got a very, very short time between presentation (of symptoms) and ICU admission,” he said.

“The number of days between having no patients with SARS and having a lot of patients with SARS is about 3 to 4 days. Avian flu is unlikely to be better: if anything, it’s likely to be worse. If you haven’t started preparing already, go home and start now.”

thanks, kmc.

janetn, the idea is for hospitals to start their stockpiling now. O2 concentrators for alternative care facilities, portable ventilators for overflow, triage when that fails.

The fact that this is being discussed at all is ahead of the curve.

One good thing there:

“If you haven’t started preparing already, go home and start now.”

It’s not about morale; it is about, listen to yourself talking about “How to do the Impossible”.

If pandemic influenza occurs now, before millions of effective vaccine doses and preventative courses of antivirals and major public education and stocking up and financial planning for stopping business as normal has been accomplished, it is impossible.

If mortality rate remains high, (and even if it dropped to 1918 figures, which varied wildly, depending on region) and we can certainly expect more than one wave, or, a couple of strains lapping each other and many months of misery,

there is no way they can continue to provide modern medical care. (Not for even a week, if 30% of the populace, including HCW, delivery people, suddenly all fell ill and disrupted everything.)

We aren’t talking about just finding a 100 extra vents and staff for each region for a month.

The scope, and the problems, are much more complicated than that. It doesn’t seem like they are planning for real “worst case”, and we need to prepare the public for taking losses and dealing on a household or neighborhood level.

If a pandemic strain appears and is significantly less contaigious or virulent than expected that would be doable, but planning as if it might be a normal-time surge and saying all people must work is short-sighted.

See how many would volunteer. It is years to train up people, and the survivors will need a staffed health care infrastructure.

Even phone hotline staff are going to be mentally traumatized.

We know what emergency call transcripts will read like. If people’s family members get ARDS or even just don’t have their Rx meds that keep conditions under control, it will be so hard, telling frantic people that not much can help. The counsellors are going to need counsellors, if we have a 1918-and-worse event.

Doesn’t mean we shouldn’t be planning for worst-case, and, if the public can’t really be helped by large systems, getting the public the info now they need to cope on their own is important.

Well discuss away -they better start doing something and it not just vents and concentrators you need delivery systems if I dont have tubing and a cannula I cant do squat with a concentrator. While they are at it they better figure out how they are going to get PPEs too Cause this is one nurse who isnt going to be anywhere near any healthcare facility without them - and Tamiflu> My first responsability is to my family - my kids and grandkids and husband. I will not risk dying because some bean counter figured Im expendable and didnt have PPEs top on his list. Tamiflu Im sure will go to the management and politicians before me. Michigan has 36,000 doses ordered - not enough for the lowly nurse Im afraid Ive run the numbers. After MDs First responders and Politicians get theres Im SOL.

Politicians and administrators are a heck of a lot more replaceable than nurses, post-pandemic. Half their underlings could keep things ticking over ok, afterwards, without them.

Hm, since HCW have to do trigage anyway, you’d think someone would have given them better priority. Guess the plan-makers and bean-counters are pretty sure they won’t be personally touched by pandemic?

A friend in Tennessee told me yesterday that her doctor told her there was nothing to be concerned about regarding BF. He told her they had lots of Tamiflu stockpiled, more than enough for everyone. He also said that the BF would only only be a problem if it mutated along with the current flu virus that has been around this winter and there is little chance of that. Luckily, my friend believed the things I’ve been learning from all of you the past couple of months and is beginning to prep.

Allquiet—I have met many clueless physicians in my years in the medical industry. They are just as prone as their patients to wishful thinking, biases, and being so damn busy that they can’t stay informed on everything medically related.

Once people get really sick, is there any thing health care professionals can do for them that their families at home can’t? I imagine, keep them clean, keep them hydrated. If the flu hits, we would probably all get better care at home than any hospital. I read that they had done an crisis analysis and figured out that it was more important to keep the water, electricity, garbage and police going than the hospitals. Think about it. Masses of desperately sick patients- underrescourced doctors and nurses

“I have seen a Knight run at the first sign of battle, and I have seen a lowly squire pull a spear from his own body to defend a dying horse. Nobility is not a birthright, it’s defined by one’s actions” ‘line from Robin Hood, Prince of Thieves’

This corny Costner line illustrates a point. These academic exercises in who will run and who will fight will not determine what happens when the fight comes. I have ask many of my colleagues what they will, not would, do when the pandemic comes. Most say the same thing. They will not stay or fight. This disease ifs far from the minds of the average HCW. We are up to our asses in sickness and disease as it is. We are also up to our asses in working conditions, merit raises, benefit issues, institutional politics, who’s sleeping with whom, what’s on the lunch menu and all the things that occupy the minds of every other working stiff. Most here are of the opinion that the Institution I have worked in for over thirty years will fold in a few days from poor leadership, profit hungry executives, undedicated workers and fear for our own asses. Perhaps you are right. Katrina didn’t help our image much. I know some of the RTs from Charity. They’re just working stiffs like you and me. I know some of the RTs at St. Anthony’s in OKC. Working stiffs. No hero-wannabes among them, I assure you.

This virus is an unknown enemy. You may know it and Mike Osterholm may know it, but most of our HCWs do not. We do not like disease. We do not like it killing our patients. We don’t like to lose. Regardless of the superficial covering most HCWs show the world and even each other, there most often is a hidden face you never see. It is the one that looks back into eyes that say “I am afraid” or “Please help me’ or “Please save my child”. I have no reservations about what I will do. I have faced danger more than once in my career and did my job because I could. I almost died once doing it. I do not confuse courage with stupidity. No amount of money could get me to expose myself intentionally to a disease that carries a 50% mortality rate. Not even for Fear Factor. Once you have seen those eyes, you cannot turn away. It is real, it is now, and it is life or death. They do not draw straws to see who throws themselves on the grenade, but someone always does. It is not individual courage, it is a cultural one.

Someone always does. And someone else, perhaps without a license, will volunteer.

The whole paradigm would be different. How to care for youyrself at home. How to do without. Again, not everyone will opt out. But most assuredly not everyone would opt in.

ok, So we all live somewhere. My family will move out of two homes and into one large third home. We plan on using one of these abandoned homes as our own care for the sick place. That leaves one open for the use by a hospital. Hey, it is only property. People are first. Are others planning on leaving their current place and getting together like this? You could care for twenty patients in one of our homes. Outside the box people.

I’d love to transplant Dr.Charles Gomersall from HK to Philadelphia. The doc who is in charge of creating the pandemic flu plan has been putting me off re: even just observing the process and is known to be critical of preparing for SARS.

That’s It Dude!! If you Co-op now, you could put together a decent infirmary. A little money and a lot of determination. Find a doctor, a nurse or two, a respiratory therapist or two, the list is long, but NP,PA,EMT, whoever you can find. Find an owner of a DME company, (very important resource person). Say “come with me if you want to live”. These resources are everywhere,…now. Can you sell a future in a future? Put the portfolio/prospectus together now. When the time comes, it will sell itself.

IMHO the pompous asses in healthcare (and we know who they are) will cut and run, and the quiet, nerdy, or just dumb smucks like me will stay. Hey, I’m 54, raised my kids to adulthood and have lived long enough to see my first grandchild. Let a young nurse/single mom HCW stay home with her kids. I’m an ordinary person, as are the thousands of nurses like me who started working in healthcare when it wasn’t glamorized, on J&J commericals or well paid (first job 1973 $4.25/h) The people who folded used boxes at a local drug company, and my sister in law who is a hairstylist made more money than me for years.

      It just who we are and what we do. It’s as much a part of me as my eye color.

Playing Chicken With Bird Flu. I am much younger than Grace, (52 on Monday, ;)) and my grandchildren are lovely, too. During Nurse and RT Week, we got little chocolate muffins, lapel buttons soliciting hugs and a coffee mug, yada,yada,yada. We get tutored by management on smiling, customer service, and “can I get you anything else” fuzzies designed to “keep em coming back”. “I want to be a nurse so I can help people” died a long time ago. Our heritage is forgotten, but not lost. It will, awaken. It may not be enough and we might all die horribly. I, for one, am not going to let some pip-squeak, sub-micron, low life, (or not even that) virus push me around. (They didn’t give MMPIs when I became a respiratory therapist).

Where is Knute Rockne when we need him?

It’s as much a part of me as my eye color. > Grace, Nursing is for me as well. I was a nurse, in spirit and in how I conducted my life long before I earned the creds. I’ve always gone the extra, extra mile for clients and truly feel my life purpose is to serve. I hope to be able to do that no matter what but I must admit the possibility (to myself) that if the pandemic is as bad as we know it could be, that I may feel it vital to stay home to help a pregnant daughter deliver (because obs are now doing triage or are dead) and to help with the existing babies. I wish I knew what the future holds and if it will be possible to help the larger group as I’m so predisoposed to do ethically and professionally, but I just can’t be sure until that day comes because the circumstances may be beyond our wildest imagining.

Grace, it’s been decades since I worked as a paramedic, but I still feel like one in my heart. I left the profession, regretably, after being injured on a rescue. Took me a couple of years to get my health back. Should have gone back (one of life’s regrets) but by that time, I was making 3x what I could make as a medic and I’d let my certification lapse.

Now that my 2nd (and 3rd) careers have been KO’d by chronic lyme disease, I’ve decided to put myself back in the saddle if a pandemic comes our way. I’ve already discussed it with a local doctor, and will do in-home patient visits for him.

Life takes strange twists sometimes.

“Life takes strange twists sometimes.”

Amen, Fla_Medic. I started a littlw wiki with some friends last summer and now it has become my new career.

Tough call.

The little guy who I read to every night comes first. I have no guilt. Family first.

note: I have been reading the pandemic Emerg Ops plans from several states, FL does not have one that isn’t BS politico talk, and I have seen no mention of providing any Rx help to any family members of EMS staff who put themselves in harms way. Even so Tammiflu is contraindicated for <12 y/o’s. So he sits alone in bed with daddy out of site. No chance.

Medic, with your wit and warmth, you could give a lot more than medical assistance. People like you will fill the vacuum when your community is floundering. I think that by getting a mental handle on what’s coming, a lot of people on this site will step up with some stable leadership in neighborhoods when the need arises. At least between waves.

The only hospital treatment for severe bird flu is a ventilator, 80+% are already in use NOW in US hospitals so there’s no surge capacity. All other treatments are palliative and can be done at home. So, hospitals won’t work, so you won’t have to, either. I’m hoping that shortly after pandemic breks out, hospitals will tell people NOT to go there.

These posts are profound, moving and very important. You are the people that we will be relying on. What a shame that you do not represent a ‘task force’ - so much could be achieved, ‘real’ information could be passed on to so many.

Melanie, when I first visited fluwiki, I was a sceptic and thought you were all a bit bonkers. Still, I kept coming back and have gone through my own paradigm shift. This thing may never happen but what I have learnt here may one day save the lives of me and my family.

Sorry, skeptic (although some would disagree!)

hospitals can do more, including use portable ventilators to triple their ICU capacity. It won’t be enough, but every life counts. And a ‘standard of care’ to ‘sufficiency of care’ paradigm shift allows for makeshift floating hospitals for IV and oxygen care. Some express skepticism, but it can be done. We’d still be overwhelmed, but more lives would be saved by doing it than not.

all the necessary equipment can be ordered in advance. Advance planning is the key.

The tougher question is where the tamiflu should go… HCW prophylaxis or patient treatment. Not an easy one. Also something that rquires advance planning.

All the above is happening in some places and not in others. it’s time every community got involved, but there’s a rhythym and a flow to the tides.

This page has been linked and sent around. Some admin types are reading this. I hope your level of appreciation has gone up.

And, folks, you can send this URL to your local paers and hospitals.

Thanks Dem for spreading it around to the right people. I just hope they have the vision and courage to start doing something proactive now, instead of waiting.

Anon,

Frankly, I wondered if I wasn’t a bit bonkers, myself.

DemFromCT: That is not a “tough question”. Without HCW prophylaxis via Tamiflu the community at large suffers immediately and then far into the future. And this statement is not one of self-interest. I will not be on that “frontline”. I have others in mind.

Also, I believe from what I have read that using Tamiflu prophylactically would be less likely to engender resistance, at least not as quickly. Correct me, if I am wrong.

it is a tough question. The median age round the world of involvement is 13. We’re talkin’ about ‘young people disease’. No matter how logical now, think of what the comments on this page have been about protecting the kids. And if the kids might be the ones benefitting from (or competing for) the meds… ??

You get the picture. Rationing is always an ethical issue. Always. Who gets to decide?

The Government.

Local or state? Hospital by hospital?

The CDC has known for YEARS that an influenza virus would likely be the next big killer in the short-term. Too bad the politicians are for the most part lawyers and not enough scientists in the group made enough waves about increasing funding for this eventuality. It would have seemed prudent to include “sel-sufficiency” planning in Homeland Security. So now we are back-ordered on Tamiflu. Let’s just hope something else (new anti-viral, vaccine, etc.) comes down the pike to turn the tide. Well, we can hope, anyway…

Everything will be rationed. Vents, equipment, meds, hospital beds and vaccines. The reason I’m stressing it here is that the Ontario group, which has studied and lived the questions already with SARS, stresses ‘reciprocity’. If HCWs risk something, what do they get in return? Scare rationed meds, vaccines, etc? And if not, why not?

it has to be part of the planning, and DA, I suspect it’ll be decided at the state and local level.

DemFromCT: If it were my kid, I would want him to have the Tamiflu. But logic has to prevail here. As of now, we have so few tools to keep society going, if this hits hard. And every healthcare worker who gets through a pandemic unscathed will be a godsend for the community at large. Those surviving healthcare workers will be saving many more kids from other ills far into the future.

President Truman dropped the Atomic Bomb (twice) on Japan and saved maybe a million lives, and my own father’s life, too. (He was in the Pacific Theatre at the time and was being prepped for the coming invasion).

Thank God Truman was logical. When you have a ruthless, unthinking enemy sentimentality can not prevail.

And somebody has to step up to the plate and make the hard decisions---Martial Law Edict A-2.

DemFromCT Those who decide will be Government. I agree with you that it will be a combination of both state and locale in America. In the UK it will be The Government ruled from westminster and a certain amount devolved out to the regions.

Medical Maven mentioned Martial Law above. I truely believe we will see that implemented very quickly into a bird flu pandemic. I agree with this but also fear where it will all stop.

The UK has had a great deal of freedom and im really not sure how the population will deal with quarantine and road blocks plus other restrictions.

We are seeing riots ever more frequently here with mass demonstrations usualy by incomers and I wonder what these people will be capable of with a reduced Police force.

If I were in Government I think I would be very quickly getting the population on board with regards to the antivirals and explaing now what is going to be happening. Unfortunately our government has an alomst paranoid obsession with secrecy and witholding information from the public. They should trust us more and give us a little more credit.

My choice for who gets the Antovirals would always be the first responders and their immediate familys. Only essential Government personnel and the military.

As has been pointed out above there are going to be some very tough decisions to be made and political correctness and the “ Goody goody “ mentality needs to be thrown out the window. Hard tough sensible decision makers in the positions of power and influence displaying true leadership is what will save us. At present such people are hard to find.

Devil’s Advocate, I’m in agreement with you. Our Government is represented by ‘sound-bites in suits’ and we no longer seems to have any statesmen. They are obsessed with new legislation, eroding our democracy and not actually doing much.

We are crippled by PR, PC and pressure group opinion, and go round and round in ever decreasing circles whilst in the distance, Rome burns.

I dread to think how we would cope in a pandemic.

I wonder if sometimes we are the “ruthless, unthinking enemy.”

Whoever ends up making these cold, calculating, hard decisions for the rest of us will certainly be vilified, prosecuted, and maybe even strung-up. But if I were at the “top of the foodchain”, I would rather be remembered for decisive action that fostered the continuation of society. And I would avoid at all costs the contempt that WHO has so far justly earned.

Our two nations, (North Americans), have a history of being un-prepared. We seem to act the best when picking up the pieces or after someone hits when we’re not looking. Our mood swings seem to come from long speculation and debate. When our common freedom or security is threatened, we seem to move more closely as one. Not always, but when it has counted. Only when the politicians realize that there might not be a next term will they jump on together. Even then, there will be those who say “my opponent voted against flu prepping”. The lack of real referendum keeps us from acting promptly on most things, but does seem to keep us relatively stable. We manage to save and protect our resources and assets as long as they flounder over a generation or two. Our just in time economy seems to parallel our nick of time sense of stewardship. H5N1 may awaken the giant filled with a terrible resolve. I might also kill the giant in his sleep

bumped for newbies… one of the very best threads ever on Flu Wiki.

I have been kicking around the idea of volunteering to help out so that some of those nurses with young children can stay home. My kids are older and dad is taking an early retirement and would be home anyway. If I could just stay there, bring a sleeping bag and call a bit of office space home. Both hospitals here are within a 1/2 mile of our house, I could walk over and stand across the street and see the kids every day. I only have CNA skills, but even that would help.

A few thoughts for those who struggle with family vs work.

No matter where you work in human services, there is an implied contract: I will do my work in a safe environment. If the environment is not safe then the contract is broken and I have no responsibility to the organization.

People will be needed in the second wave and those with serious responsibilities at home will be needed in the community as well as in the work place. Serve where you can do the most good for everyone (family and society)

There appears to be some sort of anomaly in the deaths I read about in the observed clusters. Apparently one or two siblings and one parent dies. The other parent apparently survives. I have read of no case where both parents die. This seems to be a consistent phenomena in many of the clusters. Even with a 50% kill rate, it appears that one parent survives. Assuming that both parents (where available) care for the children this seems a strange piece of data (if indeed it is true). Whether or not this would be true in a pandemic is food for thought and I wonder if anyone has looked into differential biological susceptibility to the flu.

My professional association is currently working with the Agency for Health Research and Quality, (AHRQ), the research arm of HHS in developing a “helper” training program for respiratory care. Recruiting lay or medical assistant types, the program will teach enough basics where, under proper medical supervision, these Just In Time assistants can extend the hands of a thinning RC staff. AHRQ says they are looking at similar programs for other fields. This program appears to be directed at Pan Flu. I would like to hear some positive responses to this action, as most of the time, I hear only cynicism and defeatist statements about anything the government or HC industry does.

rrteacher, I am afraid that will be too little too late;

the public does not know to not get infected, and they are not prepared to eat and drink for months of supply chain disruptions.

Theirs is an isolated, epidemic plan; not a pandemic plan.

The medical approach will only work if not too many people get not too sick. It is known pandemic will get high ammounts of population sick, in each wave! All the medical care going on now will be adversely impacted, too.

They have not done the right math for current H5N1 conditions; supplies and workers will be gone after the first week and then what?

The only high-attack rate, high-mortality rate, and months of pandemic answer is a non-current-system one

and all are mistaken for thinking shielding the public

from knowledge of expected worst-case, and, participation on preparations now

is what’s called for

in the odd name of “preventing panic”.

Ignorance causes panic not information. Information causes concern and correct actions, ideally.

the very same crooked politican that gave the you will work order, will then flee with his family to a safe goverment bunker. the real kicker is this underground city was paid for by us. shades of dr. strangelove with a dash of twilight zone.

Yeah: if it’s so safe, make the politicians stay and help at the hospitals.

We are all in this dilemma. Nurse or not. The bottom line is if we are prepared and others are not we will all be making this type of decision; turning away hungry people or whatever. You are not alone. I think it was Etiology that said if people do not take precautions that it is one way cleanse the gene pool.

rrteacher – at 11:15

rrteacher, I think is a terrific and necessary idea. If people get through the first wave and survive (and most will) then some will volunteer. Whay not for what you’re describing?

Not everything the govt does is wrong, and not everything is wrong because it’s the govt. That’s one of the first out-of-the-box programs i’ve heard.

I also remember someone saying that all the residents of the 9th Ward in NO should have gassed up their SUVs, filled them with bottles of Evian water and motored up the Interstate to a Sheraton. There are many less fortunate and and less informed that will suffer.

“If those people in Somalia would just get a job, they would be better off.”

caesar – at 16:48

Not everyone in govt is a politician. There are plenty of career people who do their job very well at the fed, state and local level.

Hopefully we will be able to have online services so that nurses/doctors could give advice (from their home) to those that have chosen to “self-quarantine”. That being the case couldn’t nurses suggest that they work in their neighborhoods (or online) should we have a pandemic and therefore be credited for their work.We have no intentions of using hospital facilities or any other “mass people gathering centers” (look at Katrina). Reading “The Great Influenza” halfway through and already it is absolutely clear that gathering sick people in one location makes no sense. The practice of large hospitals for a pandemic makes no sense. Who ever thought gathering large numbers of people in an emergency, putting them in crowded condtions and expect their survival rate to improve has to be nuts. We even have a heated 4 car garage (needed in Western Canada). We’ve decided if anyone is desperate for help we’ll convert it into an quarantine area for those needing a roof over their head. I must admit we don’t intend on bringing anyone to live in our house. I’ve also decided that if people are well but need food/shelter/supplies that they will have to either work for it or pay for it. We shouldn’t be expected to give it away for nothing unless they are in poor shape. This idea evolved after weeks of thinking about what to do for others. Rather than dog eat dog I now think in terms of give and take.

Prepping Gal – at 17:28

Those are wonderful concepts. No one is ‘entitled’ to your prepping but yourself and family, yet communities have needs, too. The elderly lady down the block will be looked after by someone, as she has no family.

Small community units will have to fuction with the ‘give and take’ you suggest. Don’t forget however, that heart attacks and other non-elective emergencies will still go to the hospital. During panflu conditions, other problems dont go away.

I Have No Shame-(minirant) It seems that a majority of preppies believe that the healthcare establishment will collapse shortly after the pandemic begins and we will lock the doors and all drink cyanide flavored Kool-aid. I work in a fairly well equipped and staffed hospital and we are ‘overwhelmed” on a regular basis. I really resent this character assessment and assassination. Even during the worst hours of Katrina, Charity did not fold. They were weak, tired and scared. They were poorly equipped and trained for the conditions they performed in, but they did perform. All we see now is Anderson Vanderbilt interviewing Dr. King about the murder of helpless patients. At least most here have the sense not to go to the hospital if they’re not sick or only mildly ill. Thanks in advance because the “walking stupid and uninformed” will already be crowding our triage areas. By all means stay at home and don’t get infected. If you get sick, self care with advanced preparations will be the best chance you have. If there is power, the lights will be on in your community hospital and some will be there. When the sick show up, someone will be there. It might not be HCA or Kaiser-Permanente, but someone will be there. It will probably be “Charlie Foxtrot” throughout, but lives will be saved. About 45% of them at any rate. Some of you should cut and paste your comments to a letter to your elected officials demanding more to be done for community, city and state preparations. You can drop a dollar in the jar or send an apple pie in support or even offer some encouragement. Also, any ideas along the lines of preemptive moves that will bolster or improve our response would be appreciated.

rrteacher. From what I have been able to read on the 1918 Pandemic, the doctors and nurses acted heroically in many instances in what must have been a desperate situation. I think my big concern is that during the next Pandemic, it won’t be that the doctors and nurses won’t be willing, I imagine that there will many or more heroic deeds and sacrifices made. I think that many of us have a sense that things may be so overwhelmed, every aspect of society, including healthcare, that we are here, reading, researching and learning, so that we will not be an extra burden on society during what is bound to be a very desperate time. So for all of you in healthcare, I appreciate what you do EVERYDAY, and thanks. I love Corpus by the way.. my father-in-law is down on the island now. :)

In reference to 1918, God bless them all but they didn’t even know what a virus was much less the capability of mapping its genomes. They had no N95s and no capabilities for medical support of sick patients. We will fare better. The one constant in acute care medicine, is go ape-shite after TSHTF. Drowning in my own secretions and lots of dead people stinking up the place really puts my clinical skills off. We are not stupid, as we read the gory details of the case reports and can smell the death up close. We feel, cry and fear like everyone else, but our conditioning will steel most of us enough to keep our hands clean and our noses covered so we can render the best we can with what we have. A significant amount of assistance can be provided without having to go into the “hot zone”. Quarantine doesn’t necessarily mean Manzanar for anyone with a sniffle. Transparent planning will begin shortly after good leadership and confidence replaces bad leadership fumigating* us.

• Reference to 19th Century method of resuscitation involving blowing tobacco smoke into the victims rectum.

rrteacher, how i know where the phrase “blowing smoke up my ass” comes from. It meant that what you were doing really didnt mean anything and wasnt very helpful. Holy Sh

Lessons from Mexico City earthqake.. You go a lot to learn from your sunny neighbors. The eartquake in 85 gave a shiny example of people governing them self in the lack of “ a cavalary”. I bring you both sides in this story, I have gotten a link from the Worldbank, and the Grassrot point of view. Notice the IMF atempt to take the credit ;-)

lhttp://www.infoshop.org/inews/article.php?story=2005090808161622

http://www.worldbank.org/html/fpd/urban/dis_man/mexico.htm

There a great number of articles on this story to be found on the net. Also others disasters have produced this great collective thinking. Just don expeck to find it in the main stream media..

LET ME GIVE YOU A PERFECT EXAMPLE OF A HEALTH CARE SYSTEM WITH ITS HEAD IN THE SAND.

I AM AN RN WORKING IN A MIDSIZED HOSPITAL DESIGNATED AS A TRAUMA UNIT. I PERFORM IN A CRITICAL CARE SETTING WHICH IS SUFFERING FROM A COMBINATION OF CRITICALLY SHORT STAFFING, UNDERSUPPLIED AND OVER THE TOP CENSUS FOR THE LAST 6 WEEKS. WE HAVE A NURSING CEO WHO DOES NOT BELIEVE IN “STAFF RELIEF” OR BRINGING IN AGENCY NURSES TO HELP OUR EXHAUSTED NURSES. INSTEAD, THEY DANGLE BONUSES BEFORE US AND NOW WE WORK OVERTIME, SOMETIMES TO 60 HOURS WEEKLY WITH VERY SICK PATIENTS, TRAUMA PATIENTS, PEOPLE WHOSE OUTCOME IS IN OUR HANDS. OUR LICENSE IS ON THE LINE EVERY DAY, EVERY HOUR. YET THE MERE MENTION OF “BIRD FLU PANDEMIC” GETS YOU THE SPACED OUT, GLASSY LOOK OF “YOU FORGOT TO TAKE YOUR MEDICATION TODAY.” OUR ADMINISTRATORS HAVE THEIR HEADS IN THE SAND ON A DAILY BASIS. DO I HAVE A CHANCE IN HELL TO CONVINCE ANYONE THAT THIS FEAR IS REAL? NOOOOO WAYYYYYY!!!!!

WE ARE IN THE MIDDLE OF A TWICE YEARLY EVENT IN THIS CITY, WHICH IS MARKED BY THE DEATH AND TRAUMA RATE WE RACK UP DURING THE EVENT. WE DON’T HAVE CAPACITY FOR THE MULTIPLE TRAUMAS THAT CHOPPER IN DAILY. OUR OR WORKS AROUND THE CLOCK, SPITTING OUT HEAD INJURIES AND BROKEN BONES. WE CAN’T STAFF OUR INTENSIVE CARE UNITS, OUR OR’S, OUR PACU, OUR WARDS. BUT HAVE THESE ADMINISTRATORS CANCELLED ELECTIVE SURGERIES OR ADMISSIONS? NOOOOOOOO!!!! RACK EM IN, THAT’S THEIR MOTTO.

WHAT IS GOING TO HAPPEN WHEN, NOT IF, THE FLU VICTIMS START SHOWING UP? I BELIEVE THIS STORY IS ALL TOO FAMILIAR THROUGHOUT HOSPITALS AND HEALTHCARE WORKERS IN THIS COUNTRY. THEY DON’T HAVE A PLAN!! THEY DON’T HAVE A CLUE!! I KNOW OUR HOSPITAL HAS ONLY A 25% STOCKPILE OF TAMIFLU. WHERE DOES THAT LEAVE THE REST OF THE STAFF? AND THEY EXPECT US TO SHOW UP TO WORK, BE INFECTED, THEN GO HOME AND SPREAD IT TO OUR FAMILIES? YES WE ARE THE FRONTLINE. BUT I CAN PUT DOWN GOOD MONEY THAT HOSPITAL ADMINISTRATORS WILL BE THE FIRST IN LINE FOR THEIR FLU VACCINE DOSE.

ANONYMOUS, DO YOURSELF A FAVOR. STAY HOME, CHERISH YOUR CHILDREN AND PROTECT THEM FROM HARM. STOCKPILE, BE PREPARED. RESIGN YOUR POSITION AS SOON AS YOU EVEN GET A WHIFF OF WHAT’S COMING DOWN THE PIPELINE. WE’RE NURSES. WE CAN WORK ANYTIME, ANYWHERE, IN ANY STATE. THAT’S THE BEAUTY OF OUR PROFESSION. WE’RE GOING TO BE IN EVEN HIGHER DEMAND IN THE AFTERMATH.

NURSING IS A HIGHLY UNDERAPPRECIATED PROFESSION. OUR PATIENTS APPRECIATE US. OUR ADMINISTRATORS DO NOT.

DO NOT RISK YOUR LIFE AND FAMILY FOR A JOB THAT YOUR HIGHER UPS DO NOT APPRECIATE. IN THE END THEY’LL THROW YOU UNDER THE BUS AT ANY OPPORTUNE MOMENT.

XO XO Nurse, your point is wll worth noting. It would be easier to read if you took the ALL CAPS off. Thanks and keep up the fight.

Please don’t use all caps when posting. It’s considered shouting. Thank you.

I also should have mentioned that I think XOXO RN makes a very good point. Her portrayal of the medical system under managed care seems quite scarily accurate. What I’ve heard from the medical social workers that I know is that the system is run by clueless bean-counters, many of whom act as though the only answer to every problem is to work line staff, particularly nurses, harder and harder—until they drop, go out on extended sick leave, or quit in exhaustion. The lack of planning at the top is really inexcusable and I can appreciate her lack of trust in a system that has been systematically negligent or even abusive to its workers. Nurses get it coming and going—from doctors as well as administrators. If this pandemic happens, and let’s hope it doesn’t, all of the ways that we’ve allowed our basic institutions to erode will become painfully clear.

Maybe she means to shout. I certainly sense a very high level of frustration and sympathize with her plight.

sorry about the caps….. i’m just 40-ish and these screens are REALLY hard to read.

:) I can relate to that. By the way, if you use the Firefox browser you can increase the font size of any screen on the internet by simply by using the “control” and “+” keys together. It helps if you have middle aged peepers, like some of us do.

p.s…..she is a he. RN’s come in all genders. common mistake.

Here is my thinking— If my cup runneth over I give— If my cup needs filling I let someone else have the joy of giving. In short, there are a tremendous amount of single people out there like myself and while I am not a nurse I would certainly be able to step up and assist- there are many other single people that I think would also do the same. What is the point of saving self at the cost of families needing help—children in particular. I have two of the most beautiful nephews in the world I would be heart sick if my brother and his wife put other people before thier children, no matter what the cost. I believe there are really good people out there and while like “Katrina” you may not hear about the Good people first you will hear and you can know that God does send angles.

there would be a major role for volunteers.

I wonder if anyone has considered the fallout post event. If you stay home will fellow healthcare workers who worked through the worst of it want to look at you much less work with you. I think about how people who collaberated with the Nazis were treated post WWII.

I am not a nurse but I work in healthcare. I have worked in the past as an LNA and a Pharmacy tech. I am currently in an outpatient setting.

Understanding the risks…I will still go to work. We function as a society because people are willing to give up in order to gain. I understand that it may kill me. However, there are worse things than dead to me. Living in a world where people will abandon others at the first side of danger is worse to me than dying.

I understand that others will make other choices. But I must add the perspective that all may not be well when it is over.

(Administrators might have a major role to fill working triage in the parking lot…and pitching in with the morgue.)

Of course, I would want the nurses to use some restraint… they’d probably need to.

I would hope when it is over both the people who stayed home and the people who didn’t (and who survive the waves) can see they each made their own choices using their own best judgement.

Society needs healthy experienced health care workers after pandemic; we can’t do without for years, and train up a (from a possibly depleted) new generation, skilled medical personnel.

If some HCWs staying home means fewer traumatized orphans, that is good for society.

If some health care workers staying home means they were able to give medical advice to their neighborhoods when regular medical care was unavailable, possibly even hands on-assistance (helping a few people in the neighborhood with broken bones or births would use less PPE and disinfection protocols than seeing a hundred patients at a hospital or hospice tent) that would have been helping society.

Nothing so far makes it look like H5N1 pandemic would just be “the busiest day now, but, last a few months”, and we’ve seen how politicians and businesspeople have let our health infrastructure decline. (I guess that is the public’s fault too for political apathy. We do not need a health insurance industry.) They aren’t preparing the public for really-worst case, and they aren’t stocking the hospitals and getting effective vaccines for the health care workers (military and top govt. politicians first). They don’t have enough security lined up for hospitals during pandemic, and feds and state can’t really help.

If the mortality rate remains catastrophic, I do not expect health care workers to be forced at gunpoint to try and staff hospitals, that so far, if pandemic breaks out next month, will probably be out of supplies of everything in under a week!

They will not be able to provide medical care to pandemic victims, nor anyone else, when supply chains stop and shelves are emptied.

I do not think it wise to send firefighters out barefoot with buckets to contain wildfires, and would hope if some tried to fight anyway, and a few survived after buying a few hours before the wildfire did whatever it wanted, they would not hate the people who chose to stay away for their families’ sakes.

We truly feel that this present threat and any other threat like it is likely to stretch our global systems to the point of collapse, said Dr. Mike Ryan, WHO’s director of epidemic and pandemic alert and response.”

I grew up out west I helped fight prairie fire with a wet burlap sack and a shovel as a teen with my parents. The summer yellowstone burned a road grader could cause a fire by spark alone.

If I spend 3 months working 20 hour shifts I would not be happy to see someone who sat it out come back to work with the same pay and benefits. Yes I would judge those people. Yes I might very well hate them.

I grew up out west I helped fight prairie fire with a wet burlap sack and a shovel as a teen with my parents. The summer yellowstone burned a road grader could cause a fire by spark alone.

If I spend 3 months working 20 hour shifts I would not be happy to see someone who sat it out come back to work with the same pay and benefits. Yes I would judge those people. Yes I might very well hate them.

We have discussed this issue repeatedly here and at CE. There will be two fronts for HCWs to provide care on. The Flu Front and the Home Front. Both will be vital to our survival. I would worry less about HC Administrators and more about FEMA and the Emergency Powers the President is likely to invoke, which allows the government to seize ALL health care resources and personnel.

The law in the state of Az gives the county the right to take over our hospital in event of an emergency. Why they would want to do that I do not know, because they would not know how to run it and do not have the resources to force the personel to work! Kelly

I have a possible solution for the nurses who want to help but also don’t want to risk infecting their families…

Nurse-care lines. It is an absolute that hospitals will be overrun and will shift to trying to alieviate their burden by establishing call-in lines for medical advice to caregivers. Volunteer ahead of time to “man the phones”. You can arrange a patch line to your home phone that works during your shifts…extensions direct to a nurse’s house.

This will enable you to give medical assistance and remain self-quarantined to care for your family.

Insurance companies and large companies have lots of nurses working in this capacity now, so it can definately be done.

There is a large range of places between communal isolation and eye-ball to eye-ball with an infected patient. Many medical and support functions could be performed without direct patient contact. There will be many volunteering for “hot” care and those who cannot can provide back-up logistical and clinical support. The front cannot function without a rear echelon in support.

XOXO RN- truer words have never been spoken -Stay with us- stay on the Wiki because we need to hear you. America needs to hear you1

I think a lot of ‘readers’ like myself will be re-dedicating themselves to strict isolation! How tru the trite saying that a gram of prevention is worth a kilogram of cure!

Thanks millions, all of you, for the perspective and the tips on what to expect. You’ve saved a lot of lives here.

And may whatever powers there TRULY be, keep you and yours! And judge TPTB appropriately when they find THEMSELVES in need of medical care….

It does seem too much to ask of HCW to sacrifice themselves and their families for a noble profession in a time of need. As was mentioned, one suspects there are many ways to serve. I know there are laws governing the healthcare profession that may interfere, but it would be terrific if nurses could begin to train potential volunteers in nursing techniques now so the knowledge has time to seep into society. I would dearly love to know how to start an IV in a collapsed vein, for example — but I know it takes years of training. But perhaps you could make a lecture-demonstration video to post online on, say, how to don and doff PPE properly? That alone could potentially save many lives.

And, I don’t blame HCW for the failures of the political class in recognizing a problem in enough time to solve it — there should have been enough antivirals (including peramivir) for prophylactic use, even if it meant appropriating Roche’s license. As it is, the US government plan is to give antivirals and vaccine first to the military — I believe HCWs are #4 or so on the list. This, to me, is criminal.

As I say, denial kills.

Sounds to me like what MAY work for many is to assemble home-care packages of medicines, ORS recipes, and the phone number of the HCW in your area. When TSHTF, people could at least be told to where to pick these packages up, and what to do with their sick family and neighborhood members.

What is happening and has been happening to HCW’s, especially nurses, for years is now happening in all businesses. Workers at all levels are being treated like machinery cogs, required to work overtime, sometimes without pay, given less and less perks, if any at all, and worse and worse options for health insurance and positive working conditions. Thanks again to corporatocratic government. Maybe this situation will cause our democracy to kick into action and we will make government respond to our need for responders on the front lines, and let the wealth flow farther than CEO’s and others at the tops of the pyramids.

If you are a nurse with children and living near me, I will check to see that you don’t run out of water and food, by golly. And use my expertise with at-home child care and schooling to help you through, if I can. Stay home. Take care of your kids. Help me on the phone if you can without exhausting yourself even doing that.

Many HCW’s will be either stuck at home or at work after the first few days anyway, due to lack of transportation. Wherever we find ourselves, we will have to cope on a local level, mostly. I won’t be on the front lines during the first wave. I’ll be in isolation with my loved ones. After the wave, the first people I check on and try to help will be those who are exhausted from being on the front lines. Okay, if it is hugely awful, then so be it. After the battle, we will all have to work together and respect whatever we have done to survive and to help. Good people will do good things. Some of those blessed with bravery and committment may harbor resentment for those who aren’t. That’s the way it always goes, unfortunately.

eyeswideopen – at 03:24 and TreasureIslandGal – at 15:46

have aspects of an idea that I’ve been mulling over, especially in the context of this thread. You can tell me what’s wrong with it, why it won’t work, if it can be made to work, etc.

If we don’t want sick people to go to hospitals and if health care workers (HCW) are going to get burned out working in hospitals to the point of dropping out, and if HCW are more or less randomly distributed around the city they live in, then keep the HCW in their neighborhoods to do home rounds IF they’re willing.

Let them take on an apprentice to train in the essentials and gradually split up the territory. Have the hospital deliver whatever essential supplies can be offered.

For those with flu not showing severe symptoms health care might even be done by communicating with family members over telephone or computer assuming those services stay up.

This would be a combination of decentralized care and house calls. HCW doesn’t have to go to hospital; patients stay out of hospital unless extremely sick. There’s minimum contact with the sick person.

It seems to me something like this might evolve anyway as a pandemic drags on, but it could be effectively planned for in advance, and fits in with the idea of community preparedness.

Now - let the criticisms begin!

The real key will be to teach people to care for themselves at homne. As we move from “standard of care” (best practice) to “sufficiency of care” (do what you can), this would mean some alternatives to the hospital, although the hospital will always be open and needed (they’re full now, without panflu).

HCW including nurses and pharmacists and aides and doctors would be needed in-hospital, at satellite “fluid” hosptals (IV fluids, low level care) set up in schools or hotels, and at home. Retired workers and trained volunteers would be needed, if only to distribute information and help with triage (you look too sick to stay home). Efficiency (come to HCW) would have to be balanced with infection control (HCW goes to home).

Today’s posts on this thread have made more collective and cooperative sense than all the previous posts combined. Government leaders who began patronizingly telling us we were dreaming if we thought they would be able to help us have slowly begun to realize that it is us that will need to help them. The ideas of saving ourselves and saving our country aren’t mutually exclusive.

The Red Dirt in Okie blood compels the helping of others, no matter what.

I guess that’s where I get it.

I think Eyes Wide Open has an excellent idea for the nurse with babies: above all, take care of those babies, but share that training with others freely, online, over the phone. Clearly medical people will be in demand. I would gladly go to a chat room to ask a nurse questions.

Excellent thread. Job one seems to be to switch the health care battlefront from the hospitals to the private homes. Job two, IMHO, is to take care of the people who are responsible for the other front line. Those are the people who can keep our power and water flowing. It’s going to be a huge effort even under the best of conditions, but without lights and water, it’s going to be like a bad rerun of Little House on the Prarie. There are a lot of people like me in this country whose idea of camping is the Hilton with the door open, so in addition to learning home health care, I have to get survival skills too. All these ideas are great, like phone care, chat room care etc. We absolutely need people out there maintaining phone lines and power grids and water treatment facilities in order for these things to happen. We also need fuel delivery drivers to keep these operations functional. These workers will be the new front line in this kind of crisis, cause without them, it won’t really matter much how many ventilators are available.

Someone above mentioned that we would be back to 1918 in no time flat. Well…I think it may be worse than that. At least the folks living in 1918 knew how to do that. Do we?

Windsong

On the other hand, YOU decided to take this job.

        Was it just the money—or did you do it to help people?

I’m just waiting to see what happens…

  While your point is valid, 

I can’t imagine what some folks will do without nurses… Nurses who took a proverbial oath… Why don’t you just go ahead and tell your boss--- AND THE DOCTORS--- What you plan to do. I’m sure they will appreciate knowing who they can actually count on… people like you will help spread panic through the land in a pandemic…

Ummm, Joseph….a job is a job….a person works to live,,,,they don’t live to work….people should not be castigated for personal decisions.

Part of the problem is that, now as in 1918, there may not be much that HCWs can do without sufficient meds, supplies, and tools (vents) in any case. In 1918, so many doctors and nurses died, and without really being able to change the course of disease in so many. It will be mostly triage and supportive care, with a few heroics, especially early on. Thus, it may ultimately be better if we learn how to take care of patients in the home, giving supportive care and whatever meds or treatments we can. This is why I am convinced that training the community in nursing skills is vital. The public has yet to realize that this is what they need to learn. As per usual, realization will hit too late.

But training videos posted on the web could be immensely useful, at least for things such as donning and doffing PPE, detecting dehydration and rehydrating a patient, bringing down a fever, making a patient comfortable, etc.

This is a tough decision but when you agree to be become a member of the medical field you also realize there is risk involved.

What if our men and women in the armed forces had decided it was not worth risking their lives during Pearl Harbor, or in Europe during WWII. What if the police officer that shows up at your house after you call to report an intruder inside your house decides it is not worth risking his life because he has children at home and his life is in danger? What if the fireman that shows up at your burning home decideds the same thing? These are all known risks associated with the job.

If you are not willing to accept the risks and decide that your children are more important I totally understand and support that decision, but by making that choice then you should also decide to exit the medical profession now.

anonymous - There is one major difference. In all of the above cases, whether it be wartime defense or peacetime public service, there has been backup, logistical and equipment support for the folks you mentioned.

Thus far, in this situation, about the best we have gotten from the government is

There is something bad coming, we can’t help you, and we’d sure stock up or something if we was you.

Medical practitioners have checked in in large numbers to report that their hospitals have said “Huh? What pandemic? Its not here yet? PPE is too costly and we’ll order it if we need it”

What would you do if on the approach of an impending battle, your commander said

Good luck. I’d like to be out there with you, but I need to check over the paperwork for these cost figures for the just in time delivery. Boy those bullets really cost alot you know.

Joseph - “I” did NOT take any oath that says I am willing to die and kill my 2 kids along with me!!! YOU go sacrifice yourself and your family if you think it’s such an easy decision!

I didn’t say it was an easy decision; I didn’t say you took an actual oath…

I DID say that your point was a valid one. And I do believe that I would be having the same (inner) struggle if I was in your position…

That said, I cannot condone your decision… (YOU HAVE OBVIOUSLY ALREADY MADE YOUR DECISION!) I feel like there will be major repercussions… People will die if health care stops working. I’m not trying to upset anyone (REALLY!); just expressing my honest opinion…

oh and Anon at 0102 Go ahead and see how many nurses would be willing to accept the risk of dying for their jobs and willing to state that their job is more important than their children…you think there’s a shortage now? Just see how many would be left if they took your advice and “exited” now. I’m sure that I’m not the only one that’s not willing. When I became a nurse it was to help people, which I do on a very busy and heartbreaking cancer unit…but I am not willing to sacrifice my family for it and I don’t recall signing anything stating that that was a requirement.

Who says you have to sacrifice your children’s lives?! Can preparations not be made in advance?! Friends— FAMILY?! does a medical professional hold any responsibilty?!

That question is not rhetorical.

JUST BECAUSE MANY WILL DECIDE TO EXCUSE THEMSELVES FROM RESPONSIBILITIES DOESN’T MEAN IT’S MORALLY ACCEPTABLE!

It’s a sad fact, but people are going to die anyway…I don’t really believe that healthcare is even going to make much difference. Unfortunately, there won’t be much that we can do, especially when the hospitals won’t be prepared or even close to being able to handle this. Maybe if I thought that we could even make a difference,my decision would be different. I’m sorry for getting angry but this is an agonizing decision. You think my hospital is going to have enough protective measures for us? I’m pretty sure they wont and I feel that going in would be equivalent to suicide. That said, I would be more than willing to do everything possible to help in this situation, short of endangering my family.

Joseph, I think people will die if there aren’t enough medical supplies and facilities available. It isn’t fair to expect a person to risk her children’s lives so she can do some necessary but ultimately futile tasks for an endless stream of dying patients. It’s sad to visualize the suffering, but her healthy children have to come first. As I understand it, ventilators and the adjunct equipment are crucial to get someone through this flu, but there’s no excess for a pandemic, so we have to hope the word gets out that in each house there should be people who can help the sick with rehydration and comfort.

WHAT DOES THIS COVERSATION SAY ABOUT US??? DOES BEING PREPARED MEAN CHANGING JOBS?? I CANNOT… I WILL NOT CONDONE THIS DECISION!

joseph, you mean well, but maybe you should try decaf. You’re being just a tad insensitive (but important to post as it is an attitude likely shared by many, if not by the posters here then ‘out there’). Step by step:

• Health care workers may put their life on the line in an epidemic of any kind (Smallpox, SARS, etc).
• They may bring the virus home, risking their family and not just themselves
• plagues and epidemics are a leading cause of no-show HCWs for that reason

The obligations of HCW under these circumstances have been rigorously looked at, the Canadians leading the way. Among other reasons, that’s why we have an Ethics section on the wiki. See Ethics and SARS: Learning Lessons from the Toronto Experience, especially point #3, Health care workers’ duty to care, and the duty of institutions to support them

Note the reciprocal duty of institutions. Without that reciprocity, the duty to treat severely breaks down:

Lessons learned

I yield the floor…

Well, that’s ok. I don’t need you to “condone” anything that I do. God bless you, I guess you’re a better person than me. Btw, where will you be during this? I know, you can drive me to work!??

jospeph will volunteer as a nurse’s aide.

Well, that’s ok. I don’t need you to “condone” anything that I do. God bless you, I guess you’re a better person than me. Btw, where will you be during this? I know, you can drive me to work….I promise not to sneeze on you

oops sorry for the duplicare…I didn’t think it posted the first time.

Okay, okay- I get your point… but I’m not in the profession… It’s not my job to report to a hospital; For what its worth— I do not WANT to be in that position… I chose not to. but some people have a job that asks more of them… They CHOSE this responsibility…

…OVER AND OUT!!!

joseph - From everything that has been discussed on the Wiki for the past 6 months concerning the health care system, if even a minor pandemic develops, the US health care system will overload and swamp within the first few days. The hospitals already are run at close to full capacity, and the staff is already run at close to full loading.

It has been cited that in the entire US there are perhaps 105,000 ventilators which are needed to keep someone infected with H5N1 alive. These ventilators also require consumable supplies including tubing sets and oxygen.

It has been shown that these consumibles will be depleted within days of a major wave hitting an area. Not to mention medicines, syringes and OTC supplies.

Now then, if you could stop the shouting and chest beating for a moment and calmly answer just this one question, I would be very appreciative.:

Just what difference do you think it would make to the overall fight against an illness wave in which perhaps 100 million people become sriously ill and perhaps millions die whether the Health Care workers sacrifice themselves immediately, or rather stand back and then move in to help the survivors pick up the pieces?

Thank you for your calm and considered answer

geesh, like beating a dead horse. I chose this responsibility, yes, but I did not choose to die for it..never thought I’d have to. Guess if I would have known that there was a virus that could potentially wipe out 50% of us, when I first started nursing school, I would have changed my mind. When I chose to have children, however, I did take the responsibility of protecting their lives with my own. And, btw, I expose myself to many nasty things at work all the time…HIV, MRSA, VRE..but something that we don’t have a fighting chance to be protected from? I appreciate your feelings, your entitled to them…just as I’m entitled to mine. Until you’ve walked in my shoes..

joseph – at 12:05

some things (actually most things) aren’t black or white, but shades of grey. And for those who are reality-based, it’s important to plan for what is likely as well as what might happen. One of the huge issues for HCW is how responsive have their management, hospital, etc been? The ‘reciprocity’ taked about in Ontario is a key factor. If you’re told the truth, supplied with prophylactic tamiflu and personal protective equipment, and have been part of a planning process that arranged to watch yuor kids, would that change your attitude about reporting for work vs none of the above?

And if there’s not enough tamiflu, would you give yours up to make sure the HCW (and the fireman and the cop) got theirs? If the vaccine comes, but there’s not enough, would the HCWs go first? Would their kids go before your kids?

These are the tough questions we’ll be asking. And who makes the decision? The state or the local people?

if it were easy, there wouldn’t be a Flu wiki.

What about the notion of getting our local governments to instruct hospitals to hold “educational seminars” about isolation. The focus has to be less on treatment and more on prevention. One that insists that people change their habits. The majority of people are completely clueless about Avian Flu, much less the overall impact of a pan influenza. I (who was a critical care nurse for 12 years and have done research for the past 15 years and mother of two small children) would be thrilled to educate my community. I am sure there are many more like myself who would be willing to do the same.

My two cents worth- First off I am in mental health setting, which deals with a lot of ‘street people’. My family doesn’t ‘need’ me in the strictest sense. I am trying to prep like crazy for my family, but I will be at work. Possibly for the duration. One of the reasons I am considering taking a sleeping bag and moving into the break room is so that my coworkers who have small kids at home or are single parents WILL NOT HAVE to work. By making do with less staff, and the staff who are there putting in mega hours, we figure we can keep going for quite a while. And assuming we come out the other side of this in one piece- I expect to take all the comp time(we don’t get paid for overtime in money, but in future time off) at once and spoil myself rotten.

Thank you Eccles. You’re right on. If I even remotely believed that we would be able to make a difference, I very well could have made a different decision. I just don’t see what we will possibly be able to do with the resources as they are now.

NP Mom – at 12:22

Such ‘town meetings’ will absolutely have to happen. Some hospitals are starting, some are behind the times. They should, maybe, start with thweir own staffs, but they’re for the most part not there yet.

Having been following this fascinating thread since inception, I can sense the frustration of people trying to make the best decision they can in a vacuume. The OP, Anonymous, is serious about his or her duties, yet is working with a lack of information about what support the hospital is prepared to offer him or her. Maybe they haven’t thought about it yet, but now is the time to raise the question with superiors, “Just how much control do I have over my exposure to someone with a serious, contageous illness? Do I have the right to refuse to work if I feel the hospital hasn’t done enough to protect me?”

I also think its probably not the all or nothing situation that it sometimes seems. We are so used to preparing for the worst that it is sometimes good to back off and imagine other situations. Such as: What if there are enough masks, and patients can be isolated, and the hospital has a good proceedure for dealing with patients who have an infectious disease. Would you go to work then?

Or, how about a situation where many people are ill, the hospital is overwhelmed and really needs all the help it can get, but the virus is in a form where it isn’t as virulent as the avian flu is now. Would you go to work then?

What if your area is hit with a large outbreak of seasonal flu?

Or, what if there was an outbreak of antibiotic resistant tuberculosis at a local nursing home, and all the patients were transfered to your hospital. Would you go to work? What about if you were treating a patient who was HIV positive? What about if your hospital had a patient with legionnaire’s disease, hepatitis or leprosy?

I don’t know what the answer is for you, but the threat to you and your family is from a lot more than just a flu that may or may not happen. I think the whole thing requires a lot more thought, and a lot more working with your hospital powers that be to develop effective protocols to protect you from bird flu and many other diseases, before you can make a decision about a disease that doesn’t exist and then beat yourself up about it.

If your hospital PTB aren’t willing to listen to the concerns of their front-line workers, then that may be where your real problem lies.

HI I see a lot of comments here about coming to work or not coming to work. I want to just post my experience from Albania. I was one of the first Americans in Albania in 50 years soon after the collapse of the entire government and the opening of Eastern Europe. Albania had been isolated from the world for 50 years and when I arrived there was no food (they were fed by the Italians with relief shipments) and no functional supply and demand. In other words, there were no buying and selling mechanics as the State had originally controlled everything by an allocation method and very little food was being produced. I mean everything was originally controlled by the government including what occupation you would go into. I could not so much as buy a screw or bolt or a piece of paper. No stores were open except a few still functioning ration stores run by the government and stocked by international relief supplies. These had long lines that started around 3AM. There were no marketplaces. There were only two hotels open in the entire country (and only for foreigners) and I remember when the first private restaurant in the entire country opened for the first time. Their entire menu was chicken, olive oil and bread.

In this situation, I dealt with a number of people who had medical events. Any medical event was bad. The hospitals were essentially walls with no windows but they did have some doors and some beds. Some beds did have mattresses. There were rats everywhere but not so many cockroaches as it was too cold all the time. Dirty rags dipped in water with minimal or no detergent were used for cleaning since they were the only thing they had. Doctors and nurses stockpiled drugs and would not or could not treat patients unless they could pay for the medicines and supplies needed or were an extended family friend or (most likely) could trade them a favor or a good that would be worthwhile to the doctor or nurse. Doctors were more likely to do this than nurses simply because their expertise was more vital (just stating what I saw not making a judgment) also nurses education and training was much lower so in this country they tended to be less useful. All supplies were scarce --- needles were recycled, no syringes existed, etc. As an example, I had blood taken from my arm by having a large size needle stuck into a vein and then having the blood run from the needle into a bottle stuck under it to catch it. Nurses and Doctors holed up at night and there was only one place to take a sick person at night and that was perilous and often not staffed. Mental health problems didn’t even hit the radar screen. (Example: after driving a sick staff member to the lone potentially open hospital at night, out of the fog came a man with blood on his face carrying a small child and a knife. It looked like something out of a horror show. I have no idea what he was doing — if he was crazy or not — if the kid was in danger or not. Hospital staff were completely uninterested in trying to find out and I couldn’t find him again in fog although I tried. Heaven knows what I would have been able to do if I did find him though.) In order to even get into the hospital or get ~treated~ you had to find an “important person” to take you so you could even get access or you had to have a friend of a friend of a friend vouch for you or help you find a family doctor to help. Doctors stole from the government in order to treat patients who came to them privately. They didn’t do this for money or because they were greedy. They did this because numerous people in their extended circles begged them for help and they had the expertise but not the supplies and also because other non-technical hospital staff and supply personnel that supplied hospitals would steal medicine and supplies to sell to the nascent black market or for their friends… I think these doctors rationalized that if they kept the supplies they at least knew how to use them and could use them for the most ill people. They may have been right.

People with more influence went to the state run hospitals which had been set up by the army or the navy to provide their personnel with care because they were better stocked — meaning they generally had detergent but not much else. Families of the patients brought everything to the hospital — bedding, towels, everything and family members rotated doing the nursing care. Usually someone slept under the bed of the patient (despite the rats) or stayed in the room to avoid having the stuff they gave the patient stolen and also to advocate for the patient if there were additional problems. For medical interventions the families also brought everything or paid the doctor a significant sum of money (or food vouchers) or an important favor. The family had to obtain everything before an operation could begin including a stockpile of antibiotics, IVs and setting up the blood supplies for any surgeries. Clearly people only sought to go to the hospital in life threatening events. It seemed that the most insensitive people did the hospital admitting and many sick people just laid by the door in pain and eventually died or moved from one office to another filling in forms in long lines. Many rural people turned to their vets for medical help since these people were better know and trusted. Also many vets still had functional equipment since their equipment was less modern and less prone to breakdown. Also they had techniques that relied less upon equipment. Dental events were often life threatening. People shunned dentists since there were no painkillers and there was poor dental hygiene. This caused cavities that went untreated for long periods of time that frequently became huge infections. Then people would see the dentist who would kill the root with a week or so of treatment of small quantities of arsenic (I think) and then pull the tooth without painkillers. Important people or people with outside resources (missionaries, embassy personnel, peace corps,etc) set up their own clinics and relied on medevacing serious patients. Heat sterilizers still often functioned when there was electricity but the sterilization chain left a lot to be desired since there were no soaps or detergents. Also no gloves, gowns, shoe covers, etc. There were dingy white medical jackets which served to denote medical staff. People could come and watch their loved ones being operated on because the operation room was a concrete room with windows and a stainless steel table. It was not sterile. Disposable health supplies which were later received from some health charities were reused often. Many people used herbal remedies but the most important one was Chi Mali (Mountain Tea) which was supposed to be an all around immune booster. Onions and garlic were two other herbal remedies well used. Remember all this happened in 1991 in the middle of Europe.

My point — in an extended crisis situation with little to no resupply it seems, from my experience, that doctors and nurses will have to deal with more moral considerations than just staying home. My second point is don’t get sick, have a home stock of medical supplies so that you can help the medical personnel help you and others, don’t expect them to be better human beings than normal, and communities have to become self-reliant as well. Sorry that this is such a long post

I don’t have any tamiflu stockpiled…

Joseph. I don’t and won’t have a Tamiflu stockpile even though I could. I don’t think you are missing anything. My honest opinion, for what its worth, is that tamiflu will have little overall effectiveness in a full pandemic.

Flu Wikians are actively searching out alternatives and I have no doubt an effective therapy will be found and other ways you can avoid infection. There is information already avaliable on for example antibiotic threads and stay tuned.

Senegal1 – at 15:15

first, that’s an incredible series of experiences in a country that - some of the older of us might remember - was among the most shadowy and unknown in the world.

Your second point is well worthwhile - don’t get sick, avoid getting sick, keep medical supplies, etc.

It took a lot of rereading of your last paragraph to decide, I think, that your first point was a reaffirmation that healthcare workers are going to have a tough road to hoe.

Just in case though, I don’t think anyone here denies that there won’t be a demand for health care workers. But not even in Albania was the problem that HCW would go to work with a good chance of catching a pandemic disease and die, leaving kids at home.

Targetted not to senegal1, but to the boorish here: I don’t have kids, myself, but goodness, you don’t have to have kids to realize that it’s a whole new ballgame. I don’t have the slightest difficulty in seeing how a parent who happens to be a HCW is wrestling with this decision.

Thank you Senegal1, for the reality check.

And Sahara, they already do treat HIV+ people every week; that is not airborne, and in developed countries they have enough needles and gloves and other supplies to not spread it in the hospital or community by treating AIDS patients. If hospitals refused to buy and use those, or, the supplies needed to safely handle drug-resistant TB cases, the HCWs would need to blow the whistle and tell the public. Influenza is very, very, infectious, much more than SARS was. (What have they learned from SARS in cities that didn’t have it? They are just as unready today.)

I don’t expect police officers to promise to show up and fight criminals with their bare hands because their city or government didn’t think they needed to spend money to buy enough guns, bullets, or police cars, or armor, just because the individuals said they were willing to take the risk to be police officers.

Whatever sector of the public, who demands others show up if a deadly influenza pandemic leaves hospitals out of supplies and totally unfunctioning by the end of the first week, is just trying to make sure all our health care workers are dead by the time, a pandemic ends; could last possibly a year?

Why should they show up if the politicians, warmongers, for-profit hospital CEO’s, parasitic health “insurance” industry, indifferent and unscientific public have all made sure our healthcare infrastructure is not ready, when for the first time in history we have had months of warning of a possible influenza pandemic from an “unprecedented” deadly virus?

Communities do have to become more self-reliant.

I am tired of local officials saying they can’t give that message to their public; they will create the very “panic” they claim to abhor by not convincing them to prepare to look after themselves.

By talking about vaccines (for the few top gov and military) and talking about making health care workers and unclued-in community volunteers show up for a possibly 1918-or-worse pandemic, the most important part is getting left undone; the grassroots preparation of each household to try and take responsibilty for not contracting pandemic, not spreading it, and trying to nurse it, and live or die, at home.

Currently the system does not look ready for anything else except “you’re on your own” if it turns out to have high attack, high fatality, and children/workforce-age ARDS - we don’t know what will happen, but why aren’t we preparing against the worst first?

There seems to be no local political will to spend the money to prepare the medical system; they didn’t want to believe it was statistically probably enough to act against it, they had fun spending the anti-terrorism money, but don’t seem to want to mention this larger local threat. I also say to those who claim there is a health-care system answer to influenza pandemic to do the math; the populace would need new empty hospitals ready, stocked for siege, fully staffed with backup and guard troops, and they aren’t there.

Homes and communities have to learn how to get ready; won’t be time to do this during pandemic.

A snapshot of our healthcare system has been used as the model of response for the coming pandemic and the consensus has been “we’re screwed” and “I’m not going”. We aren’t prepared for any type of disaster. The small Gulf storm last August pales in comparison to the coming pandemic. After KatRita, my town (Corpus Christi) looked at our response capabilities and some changes have been made. Experience did that. The pandemic scope leaves us staring and drooling because of the magnitude of what will change or need to change. Everything. If H5N1 comes today, “we’re screwed”.

I have been pounding on doors for months and quite recently, they have begun to open. People and PTBs are starting to listen. It’s slow, but it’s changing. The people out there are no different than we were before we came here. We just need to continue the enlightenment and have a small amount of faith that is will be better than it is now.

:)

bump

I have said multiple times on this forum and on my own blog- I CAN”T FIND THE VENTILATORS AT WALMART!! I do believe in the value of individual preparedness, primarily because it gives a family options and choices if/when a pandemic arrives. Unfortunately, being prepared doesn’t guarantee that you or your loved ones won’t get the flu. There are not enough ventilators and hospital resources in this country to care for the projected numbers of folks who will be stricken. Medical personnel will have to decide what is right for them and what they feel is the appropriate thing to do when the time comes. I work at a University Health System but no longer in a clinical position. My job brings me into dozens of medical practices and hospitals every week. I would think I would be asked not to work, since I could carry the virus all over the region if I continued my normal job. Same for all pharmaceutical sales people and others like them.

As a single parent and a widow, I am obliged first to my children. I need to support them in all ways, so being out of work for an extended period of time could be devastating, but being broke pales in comparison to being dead. I wouldn’t expect less of a commitment to family from anyone else. I don’t expect doctors, nurses, police, grocers etc. to necessarily be available. I don’t think it will matter anyway unless WalMart decides to carry ventilators.

GraceRN’s comment made me consider another important aspect concerning healthcare workers. The workforce that entered the medical field after say, 1990, are not the same sort of group that bore Grace and others like her, primarily because the leadership around that time had completely changed. Profits became the motivating force behind medicine (an oxymoron since most are non-profit organizations). The sought after administrators were the MBA’s with clever ways to enhance revenue and decrease costs. The size of the pie never changed but the slices for pharmaceutical companies and insurers got much larger while the slice for nursing and support personnel was shaved. Medical personnel responded in kind, demanding higher incomes. Patient care was sacrificed somewhere in this dynamic, leading to increased frustration in those nurses who went into the field for wholly different, more altruistic reasons. I say that every nurse that is forced to work during the pandemic should have an administrator by her side for support. Let’s see how many MBA’s show up for pandemic flu.

Most hospitals in the US and healthcare groups are now for profit enterprises, Lorraine, at least in my part of the world. Those MBAs are working to make a nickel off of every sick body that walks in the door for shareholders somewhere else. That’s the reality.

Melanie, You are right-in Philadelphia there are not as many for-profits. Probably because the market here is intensely competitive and the return on investment not as good as elsewhere. Tenet, our major for profit is struggling. There are huge moral complexities in the delivery of healthcare-this country has, in my opinion (and I have spent time elsewhere) the very best care available. That kind of high level care costs money, nonetheless insurers are still making huge profits-take a look at their stock profiles. I think it is funny that today, the minute you walk into a hospital, you are asked if you have an advanced directive. In the old dys, when hospitals could bill for days and days of high level intensive care, they didn’t mind that the dying took so long to die.

I used to work for the Cartel, (The Columbians) and recently left to work for a faith-based NFP hospital. At the end of HCAs Quarterly P&Ls sent to stockholders, is a disclaimer section which lists items to consider when forward looking stock purchase. These are things that might make HCA stock rise or fall, such as current Medicare reimbursement rules, the ability to recruit and retain staff and physicians, the cost of consumables and their markets, etc. Of 26, line items that would cause HCA to make or lose money, providing quality care to patients was not one of them. It occurred to me that Big Health didn’t need to provide good care, they just needed to provide the perception of good care. I went to work for the other syndicate, (main office in Italy) because I thought they can’t keep the money they make and God might be watching them. The big problem is NFP must now behave as FPs do to stay competitive with them. How many, do well as they are, stand alone, NFP hospitals do you remember from the 50s-80s? Lots. How many now? NONE. Everyone is in a network and if you make any money it must immediately be invested to buy the little hospital on the prairie that is no longer viable because if you don’t buy it, the Evil Empire will. They’re both really the same now.

Lorraine aka Phila Mama at 0350: re: “Let’s see how many MBA’s show up for pandemic flu.”

We know it’s the same MBA’s who push the just-in-time purchasing system and will fight attempts to stockpile essentials. My sister just completed her MBA, but she was older, more experienced and just wiser than many of the young suits she studied with. She told me multiple times how their comments were just terribly cold-blooded-all $$, no people.

Senegal1-your post left me speechless. It could have been describing the Middle Ages; I had no idea Albania was in that situation in the 1990′s. My heart goes out to you and the people who lived during that time. How is the medical situation now?

You are not alone Registered Nurse,My wife is also an R.N. Emergency Room.When and if this becomes Pandemic she is staying Home. Whats this crap about the Ontario Gov’t passing legislation that makes it illegal for front line workers not to go to work because of pandemic fears? 1 year in Jail and $100K fine! How undemocratic!We will survive, been prepping for months.The hell with the Gov’t!

I am the original poster of this message, and I would love to hear from other RN’s who also plan to stay home and self-quarantine when/if tshtf. I would really like to know what kind of a plan others have come up with for not going to work. Just not showing up? Calling and taking a leave? Call in sick? I’m not sure what the best way to handle this will be. I was planning on taking leave and/or resigning when I see efficient h2h. I cannot talk to any of my coworkers because so far none of them take me (or H5N1) seriously. I also have thought about having to go into hiding to avoid being hunted down and forced to work. Like someone said, “you can lead a horse to water…” I would be in no state of mind to care for anyone under those circumstances. I would be a raging lunatic if they ripped me from my kids. I also love the idea of teaming up with another essential worker who is choosing to work during this and maybe taking in their family to care for so they can work without worrying quite so much about thier loved ones being cared for.

We have sent inquiries to find out whether this propsal from Ontario is going anywhere. AFAIK, it was tabled and has no datefor enactment. It is certainly not law now. But we’ll see what the inquiries bring…

did anyone even consider Canada a democracy in the first place!?!

can it, joseph.

Mama Bear…….you started the ball rolling. Some of my more intelligent and perceptive co-workers….doctors, rn’s, respiratory staff….are now debating your same question. We all come up with the same conclusion….our healthcare facilities will grind to a halt, first from the lack of surge capacity, then from personnel either bugging out or dropping like flies. We choose to take care of our own, because in the end a JOB does not matter. Our FAMILY does. We can be better prepared to dispense advice, minister to the sick and comfort others if we are safe and healthy AFTER the poop flies everywhere. Again, my advice…..prepare, stockpile, be ready to dig in for awhile…then see where the pieces need to be picked up. I certainly don’t want to have to bury my dead kids in the backyard because I exposed them to a deadly disease in the name of a JOB…and that is a reality that no one wishes to be confronted with!

During Katrina there were medical staff in New Orleans that stayed with their patients through the worst of it. There were, also, nursing home owners that bugged out and left their charges to drown. What would you do? What would I do?

DemFromCT – at 15:02

“We have sent inquiries to find out whether this propsal from Ontario is going anywhere.”

Any update for this please.

Anon:

Most people predicate their advice based on the worst case scenario. What I foresee the moment the first cases jump out of Asia is hospitals will immediately begin to discharge people home and cancel all elected surgeries to free up hospital beds. We don’t have dengue fever in America to disguise flu symptoms, the doctors will recognize it. I can guess some hospitals will ban together and maybe fill up a few ICU’s through sharing leaving some ICU’s open for admit. I see some smaller hospitals designated as say the labor and delivery place during flu. I see people showing up with minor problems shipped to off site care centers (your local ortho building), or to non trauma centers for IV and antibiotics and then to home. People who dump their sick and run will get a visit by the police and will be advised to go pick them up or face a legal consenquence. I see the hospitals making it through—not collapsing. Flu victims will definetely be triaged and some will never be allowed in the building (bad luck and timing because the place is full). They would never allow bodies to stack up inside it as in 1918. People will die outside of it, but inside they will not allow it to be over run. So, depending at what time you show up for treatment, will determine the care.

Sorry, I know this isn’t a hurricane but how HCW’s respond in emergencies is known, not guessed at. We have antibiotics, and a host of other drugs not available in 1918. To compare health care between US and Indonesia is unfair and naive. If your hospital makes it through without you—there is also a predicate set for state licensing boards to refuse to allow you to work again. Likely, due to sites like this one all states might implement these actions. Nurses with serious health conditions might want to re-evaluate going in and nurses with young children like you should too. (We are human and families do come first. In your situation as a single mom, I would not go, but you should be aware its just as likely two things might occur. Yes, you may be needed in your community after the flu (in worst case scenario)and you’re forgiven, or you may never be allowed to work as an RN again, think lpn or na. Go back inside your hospital and rethink it next time you’re there. Consider how many hospitals, outpatient surgery centers, big medical buidlings like cancer centers there are and all have O2 availability and code carts. If the minimal number of HCW show up, if public broadcasts daily spew to the public what to do and what not to do, I think it will not collapse as so many here seem to think. I believe the retired and disabled nurses will be the ones asked to man phones in this scenario. Good Luck with your decision, it is a difficult one.

It’s been tabled afaik. It is not law.

BTW, this excellent thread needs to be closed becasue of length. Please feel fre to start a new one if there is interest.

This one is easy for me.Just tell my wife and kids I love them very much.I done it many times before.I’d stay to help even if it takes my life.I have had many very close calls

I work for the power company in what is considered a mission critical role (the control room for the entire utility, not just one power plant). I have 2 kids and wife that depend on me. I couldn’t live with myself if I put my job ahead of them and something happened to them. I maintain the only way to keep critical facilities staffed is to provide on site housing, food, and water for the workers AND their families. That ain’t gonna happen.