Forum: Healthcare Workers-Collective Action

I have a relative who works in the Ontario Healthcare system. As many of you have read, the Ontario government put out a mandate to order healthcare workers to provide their services in the event of a pandemic, with heavy fines for noncooperation.

In my mind, this basically amounts to the draft/conscription. I know some will disagree, but I do not want to see someone forced into a highly morbid, potentially fatal situation under the grounds that they provide “health care services.”

In a pandemic, we will all become “Health care providers.” People have a right to health care, but people also have a right to stay with their families and to darn well do what they wish by way of protecting THEIR OWN life!

The purpose of this thread is just to gauge how many also disagree with this type of mandate and to see who would be interested in taking and discussion further action because of it. (petitions, brainstorming, letters,?..?)

Other thoughts/suggestions?

“Conscription is a general term for involuntary labor demanded by some established authority, but it is most often used in the specific sense of government policies that require (very often, male only) citizens to serve in their armed forces.” —from Wikipedia

If they get Tamiflu, they should help. How is that not fair?

They should get more than Tamiflu. Ideally, their chance of falling ill should be (Tamiflu included) not much higher than at home, or even less than that if at all possible.

Let everybody take their own tamiflu.

Tamiflu isn’t going to help anybody. It is just a bunch of PR. There are too many variables and unknowns surrounding the data on its application in this particular scenario, as Osterholm indicated in his recent interview.

Besides, within one week the whole “healthcare system” will have dissolved into chaos, not the least because over have of the staff will have picked up the virus themselves.

A job is a job. You work to live not live to work. Now really….would you rather have someone see you in a forced mode on someone who really wanted to?

Roman—at 20:23

I’m gonna be there. Fair or not.

See, great example — some healthcare workers will choose to work and be there of their own accord. My point is just that it should be a choice; everyone should have a choice. Everyone should have equal freedoms.

Besides, within one week the whole “healthcare system” will have dissolved into chaos, not the least because over have of the staff will have picked up the virus themselves.

Right this is known and said by healthcare systems all the time,thats why I dont understand why they got so defensive in the other thread about who is getting tamiflu….How bout the 12 year olds first for vaccines and Tamiflu if the hospitals are closed after the first week.

anonymous,

The hospitals will be closed within hours or days. We have less than 2% spare capacity and an ordinary flu shuts them down.

Even in the absence of a pandemic influenza, I’ll need oncologists and surgeons and support staff to reach 50. I’d like to know that after a crisis, they will still be there and alive to take care of me later. I’m going to try to take care of me and mine at home so as to not to risk the hospitals, which may just make people sicker.

Not intended to put a damper on the discussion, but these topics haev also been discussed here and here (HCW and whether to show up to work).

Please note that in the Ethics section of the wiki is a goodly amount of material from Canada on reciprocity (what’s owed the hcw if the hcw owes work time).

Finally, I thought the proposal was tabled. Was it actulally passed?

anonymous, you bring up a very valid argument. In the US, many doctors are refusing to write prescriptions for Tamiflu for their patients, yet pharmacists tell us doctors are writing prescriptions for the drug for themselves and their families. I didn’t have a problem with this. I have been saying all along that I would sacrifice my option on the drug, and my family’s option to it, in order to have enough for people on the front lines. But what if they take the drug and then decide to sit this one out? Ohhhh, that would be so unethical, don’tcha think? Its not illegal, doctors can write the prescription… and we can’t exactly punish them for prepping as many of us would. But if you aren’t in a high risk group, or if you remove yourself from the activity that puts you at high risk, then I think you should lay off the anti-virals too. I think I understand what the Canadian government is trying to do here.

Roman – at 20:23 stated — “If they get Tamiflu, they should help. How is that not fair? “

Tamiflu is given to folks AFTER they have contracted the virus, in the HOPES that it will help them (i.e. they, because of their profession are “unduly” exposed to folks with the disease.) Is that fair? No, because it’s NOT a 100% certain that anything will help you if contract the virus. TamiFlu IMHO is a hope, not a certainty.

NOBODY knows IF this will play out, and HOW BAD it’ll be. Perhaps, it’ll be “just like” the last two (mild) pandemics and not equal or worse then the Spanish Flu.

Fot just a moment, imagine you are one of the “policy makers”… They have to hope that HSP’s (health care professional) will show up at there duty stations. Well, we all know that a good portion will “opt out”, because of fear, family or whatever. From what I’m gathering here, they have “ruled” that if you are a “no show”, you will be (heavily) fined. That (fear) has been enacted in the hopes that it will “persuade” the HCP’s to show up.

I applaud every HCP for their tireless efforts EVERY day they are on the job. Many within their ranks, are the unsung heroes in our society. I know some will “man their posts”, but some won’t.

I am not a HCP and I will be stayed home with my family. I am thankful that I do not have to make this decision.

“Walk a mile in their shoes”…

Do you plan to showing up at “town hall”, on day 1, and offer your assistance to your community, for the duration? Hey…. you’ll be a first responder and they’ll (maybe) have Tamiflu for you also… If you do, God Bless you… If you don’t, may God bless you and your family….

Pull the license/registration of any health care professional that doesn’t show up, never allow them to work at any position of responsibility again. Heath care has had a protected position in our society and benefited economically from it, it’s now time to pay the piper. If you benefit from a regulated, licensed and protected profession you also accept a duty to society at large as part of the game and the risk that comes with it. In this case paying back may be a royal Bi*** , but that’s life.

Seems like there needs to be more”carrot “ and less “stick”. Make people declare themselves NOW. Then, if they don’t honor their commitment (made in advance) fine them heavily. Then find a way to start (right now) rewarding the ones who opt to stay and help-reward them a lot.

No, that’s death.

kc-quiet — that’s a good alternative.

although I still disagree with the very concept of the fine in this type of situation.

Corky52 – at 21:23

Nuh-unh. You can’t ask soldiers to show up for work without guns and body armor just because they enlisted, either. Read soem of the detailed discussions from those who have been through it.

HCW do have an obligation, but only when their employers provide them with the proper tools, or give them something in return like assurance their families will be attended to.

Repeat question… does anyone know if this actually passed into law in Ontario?

kc,

Carrot has already been given and so has the commitment, look at the agreements that you sign when you get a state license to practice medicine or other “regulated” profession. It’s time for the medics to payback if the flu hits, ethics and the law require it.

Corky52 – at 21:48

Did you have a chance to read Ethics and SARS: Learning Lessons from the Toronto Experience?

Health care workers’ duty to care, and the duty of institutions to support them

The issue

“Mary,” a nurse in the Intensive Care Unit, is afraid that when she goes to work she will have to care for SARS patients and may become infected. Her husband asks her to call in sick, pleading that it is her duty as the mother of three small children not to risk giving them SARS. “Mary” feels torn. She feels her primary responsibility is to do everything in her power to protect her children. At the same time, “Mary” has a strong commitment to her profession, and the family needs her income. She has studied hard to become a staff nurse, and is aware of the importance the hospital places on good attendance. Her salary is affected by calling in sick. She also wants to support her colleagues on the front lines by going to work.

For the first time in more than a generation, Toronto health care practitioners were forced to weigh serious and imminent health risks to themselves and their families against their obligation to care for the sick. This generation of clinicians had entered their profession in an era when there was little expectation of facing deadly infectious diseases that had no ready cure. Suddenly, a large number of health care workers, particularly nurses and doctors, faced tough choices about how much risk to take. They had to put their lives at risk to help others. Dozens of medical workers, most of them nurses, caught SARS during their work. The most public example of the sacrifice by a health care worker was the untimely and tragic death of Dr. Carlo Urbani, who was infected in Vietnam.

SARS imposed great stresses on health care workers. They feared contagion for themselves and their families, and being shunned by others in case they were infectious. They suffered from disrupted routines, and loss of work for those who were quarantined or were unable to work because their hospitals had cut back on admitting non-SARS cases. Many health professionals had to wear cumbersome and very uncomfortable equipment to protect themselves, causing discomfort and hampering their ability to work. This also reduced the human contact with sick and dying patients.

Ethical values

Duty to care. Health care professionals have a duty to care based on several ethical considerations. The first is “virtue ethics” which means being of good character. The health care professional is seen as a “good person” who may be relied upon to demonstrate altruism by putting the patient’s needs foremost. When they enter their profession, physicians take an oath that they will be competent, and will use their skills in caring for the sick.

As one member of this panel put it, “when we sign on as health care providers we must accept the risks. Firefighters don’t get to pick whether they will attend at a particularly bad fire, and cops don’t get to select which dark alleys they walk down. To me it would be unethical to deny care even if there is ‘somewhere else’ that could take that patient.”

Reciprocity. Just as health care professionals have a duty to care, society and institutions have a reciprocal duty to assist these professionals. This includes providing information for staff so they can fully understand the risks, and having policies that support safety practices. These policies should avoid penalization from either a financial or other standpoint for events, such as loss of work that is not the fault of the employees. As part of this behaviour, institutions must practice transparency, and this will foster trust in the organizations by their staff.

Lessons learned

While health care professionals have a duty to care for the sick, this must be tempered by a duty to care for themselves in order to remain well enough to be able to carry out their duties.4 To extend the analogy introduced above, the fireman would not knowingly jump into a burning inferno. Where to draw the line between role-related professional responsibilities and undue risk is a question our working group struggled with, but did not fully resolve.

Health care institutions have a duty to provide the supports that enable employees to do their jobs effectively and as safely as possible. Information needs to be shared in a timely way so that health care workers are fully informed, and enjoy a climate of trust in their place of employment.

Institutions need clear guidelines in place so employees know what is expected of them, and what help they may expect. In addition, employment policies need to ensure that staff are rewarded rather than penalized for following safe practices such as staying home when they are ill. In future cases, hospitals might be able to make better use of staff in helping isolated patients make contact with their families. For example, instead of sending health care workers home with no work, they could be given the job of phoning patients and their families to provide information and support.

Finally, there is a duty for the public and persons in authority to recognize the heroism of front-line medical workers during the SARS outbreak. In Toronto, most health workers responded courageously

Dem,

You do have to show up and fight, equipment or no equipment, read the UCMJ! You commit to the job, been there done that. You sign on the line, it’s come what may, you do the best you can with what you have!

Doctors commit when they take a state license in this state, most other I’d think.

From the follow-up study (Stand on Guard For Thee):

Health Care Workers Duty to Care

The SARS crisis exposed health care systems to hard ethical choices that rapidly arose. Dozens of health care workers, for example, were infected through their work and some died. Other failed to report for duty to treat SARS patients out of fear for their own health or that of their family. A flu pandemic, where there may be no absolute protection or cure, would put far greater pressures on health care systems around the world.

“Workers will face competing obligations, such as their duty to care for patients and to protect their own health and that of families and friends,” says JCB member Ross Upshur, M.D., Director, Primary Care Research Unit, Sunnybrook and Women’s College Health Sciences Centre. “Medical codes of ethics in various countries provide little specific guidance on how to cope with this very real dilemma. Professional colleges and associations need to provide this kind of particular guidance in advance of an infectious disease outbreak crisis.”

Governments and hospitals also need to provide for the health and safety of workers, and for the care of those who fall ill on duty. This might include and insurance fund for life and disability to cover health care workers who become sick or die as they place themselves in harm’s way.

Most HCW have not benefitted tremendously economically, perhaps some Pharma and hospital CEO’s have, but not the ones who barely get any sleep as it is now before pandemic.

Sending them in, if it is a matter of “work and get sick and die two weeks after pandemic mutates” does a disservice to society long-term. When pandemic is over a few waves later, a year or so, do you want to find there are no trained health professionals left at all?

They are only saying they’d refuse to show up, because voters and government and for-profit health care has decided to cut staff, and stick to just-in-time stock proceedures.

Government has cut the CDC budget, refused to get orders in for antivirals or masks or serviceable ventilators or even vaccines, two years ago when scientists started warning about need for planning in case of pandemic. Too unlikely -low priority -don’t bother! Now, many other countries are in line ahead of the US. We have wasted money on many other things that do not help the public. Look at the tradeoffswe could have made.

Our health care infrastructure is barely functioning now in the US. We don’t force firefighters in when they don’t stand a chance, nor send soldiers off to war without weapons and armor and good planning, (well, if we get the government we deserve, “We’re screwed” for a reason I guess).

Society at large has not made good health care a priority. Government has said since last Oct. we’re supposed to be planning to look out for ourselves in case of pandemic. Others were saying it far earlier.

In very worst-case, that may mean being sick and recovered or dying at home, because that’s life for most of the world for most of history; no one owes you their life to play at a show of normalcy for a couple of days before the lack of local planning and preparation goes under like the 9th ward of NOLA.

Corky52 – at 21:53

The examples I gave are how it works in real life. Obligations are not as simple as what you present. Many, perhaps most HCW will show up for work, all will not. But you’re addressing the wrong question. The question should be what are their institutions and employers doing to support their ability to work?

It’s been discussed in detail here by those same HCW. And the SARS experience put the theory to the test.

Now, note that what the plan says as I’ve quoted it, and the (rumored until we know it’s been enacted) fines that we are discussing don’t seem quite compatable.

crfullmoon,

Succinctly said. All of the HCW I know thank you for it.

I guess the Reserves should be free to bailout as well? It’s called being true to your word, not something very popular in our modern society. If you don’t want to stand up and do the job no matter the conditions, quit now and turn in your certificate, license, whatever! Did we let out of the draft because it wasn’t safe or fun?

Dem,

Obligations are very simple you either accept what goes with the job or not, if you don’t, don’t take the job during the good parts!

Melanie- re: “The hospitals will be closed within hours or days. We have less than 2% spare capacity and an ordinary flu shuts them down.”

Hours, if even that long. At the hospital where I work, (600+ beds, Ivy League University Hospital in Philadelphia), we can easily have 60+ patients waiting for beds on a “good” day. There is no surge capacity. Period. Oh, our panflu plan? So far, nonexistant. It’s supposed to be “in the works”. We have some HCW’s who can’t get fit-tested now for N-95 masks; they have no idea who to contact.

If there’s a plan, and a stockpile of PPE’s, it’s the best kept secret in the place. We can do multiple organ transplants (high tech, high recognition) but pandemic planning seems to be too mundane for the grunts in the trenches to be informed.

As for me, I will work in the community when the time to do so arises. Not than anyone has asked.

Corky52

Read what the HCW say (provided link). It isn’t so black and white, particularly for those with children. Ontario recognized that in its infinite wisdom when they commissioned the studies I cited.

Repeating that it ‘should be’ black and white (to you) doesn’t, alas, make it so for them. Don’t be so stubborn. ;-)

Corky,

See Dem and Grace’s comments.

And Corky, what happens when 30–40% of doctors, nurses, respiratory technicians, ward secretaries, food service workers, sanitation workers, EMTs, fire fighters are all out in the same period as the rest of the population? Hmmm?

Those with kids just won’t see them, and will have to make arrangements for them, known part of the possibilities of the job, same as the people in the reserves that got called up for Iraq. HCW’s took the peoples money in the good times and now want to weasel out when things look rough. That this discussion is even happening makes me question the whole group.

Now to be fair to my buddy Corky 52 (who thinks like an engineer) here’s a further passage from the Stand On Guard For Thee report:

They recognized HCW obligation, which is considerable. But there is no unanimity on this (not everyone thinks like Roman and Corky 52). I urge anyone interested in this topic to read at least that section of the report. This is a topic that ought to be discussed, and beforehand.

Corky,

That was offensive. Infectious diseases of various kinds show up every year and your pediatrician will see your kid even when it has a chance of infecting the whole office and waiting room. You are making assumptions about people you don’t know and I find that offensive. This is going to be a horrible moral crisis for a lot of people in the middle of societal confusion. It is not as black and white as you seem to think. Go back and read John Barry and actually study some of the material on the main Wiki to get a sense of how complex this is.

Health care workers are not mercenaries and it is rude of you to treat them as such.

Melanie,

Question wasn’t about them getting sick, question was about the obligation they HCW’s assumed by taking the jobs. If the HCW’s don’t want the responsibilities of the job they shouldn’t have taken the job. All jobs come with some level of commitment, HCW’s knew the level of commitment going in, they held the jobs in the easy times, only fair they do the same in the tough times.

Corky 52, Police and fire have regular diaster training. They are provided with the tools of the trade. Take away the guns, or the bullets, or the water from the hoses the firemen use, would you or anyone would expect them to go into a riot or a fire?????

No PPE’s=no way to prevent infection=death sentence. You won’t see our CEO doing that..

i dont see why anyone else should be prepared to commit suicide for me. If i’m infectious and a complete stranger even if they’re a Dr says he doesnt want to risk his/her own life…that might suck for me but really…why should he be compelled to do so? I dont think (here in australia at least) that health care workers have been so well treated that they owe the public their lives. Of course i may well feel differently if TSHTF ;)

Corky,

And are you going to go into the office when people start to get sick? Just askin’.

Corky52

question was about the obligation they HCW’s assumed by taking the jobs.

And a good question it is. What is that obligation, and is it uniform? Nurses, techs, emts, respiratory therapists, aides, etc, are not at the top of the economic pyramid. And they are not soldiers, despite my using the analogy first. They, on the whole, did not all sign up ‘to the death’, even if you think they did.

Page 12 of the Stand On Guard report:

At times like this, health care workers’ ethical codes should provide important guidance on such issues as professional rights and responsibilities. It is important for health care professionals, from doctors to nurses to hospital and ambulance staff, to articulate codes or statements of ethical conduct in high-risk situations, so that everyone knows what to expect during times of communicable disease crises. These codes or statements should cover such issues as:

• how much risk should health care workers be required to take; • their duty to care for the sick, and to care for themselves so they can continue to provide care; and • their duty not to harm others by transmitting diseases.

There is currently a vacuum in this field.

Lots of different kinds of professions need licenses from the state in order to work. Are all of them obligated, too, Corky? Like my hairdresser, for example?

I believe this is the first health care crisis we are facing when the majority of nurses are mothers. In past generations, hospitals were staffed with nursing students, young unmarried nurses, and nuns in the nursing professions. A couple of generations ago it was rare for a married woman to work, and unheard of for a married woman with children to work.

Melanie,

No I won’t be at my office, because it’s at home. I’ll be doing the same thing I was doing during our fires down here, out being a willing pair of hands lumping and loading, as that’s about all my skills will be good for. I’ve already setup a place to stay where my family won’t be endangered by anything I bring home. Unlike some my body will be where my mouth is!

Corky52 – at 22:34

i truly believe that! I am not disparaging your POV in any way, nor your commitment. I just think you’re assuming things that shouldn’t be assumed (by any of us). ;-)

By quoting the reports, I hope to show you that it is a recognized problem, not just my idle opinion that it is. And the reports raise as many questions as they do answers.

It’s one of the reasons why we put an ‘ethics’ section on the wiki.

Corky,

With the information I got from Fla_Medic, I’ve signed up to become an EMT for the duration of the emergency in addition to my day job.

Corky 52, You’re getting my Irish up, dude…

“All jobs come with some level of commitment, HCW’s knew the level of commitment going in, they held the jobs in the easy times, only fair they do the same in the tough times.”

In the easy times? “Big money?” Until the nursing shortage in the 1980′s, the local trash collectors made more than me! With better benefits! Let me know, which times were they,as I must have slept thru them.

Would you go to work if they told you your equipment had become radioactive overnight, and had nothing to offer you for protection?

Grace,

If salaries had gotten better since the ‘80′s, there wouldn’t be a shortage today, would there? There still is a shortage. QED.

Soldiers do not have to follow an illegal or unsafe suicidal order.

Yanking licenses would just leave you with no health care now, (head for NZ, HCWs!) and you’ll still be so out of luck, Corky52.

Forcing health care workers to show up in a worse-than-1918 pandemic will not improve your nor the unprepared public’s outcome at those unprepared, unstocked hospitals; it’ll just have them be lost quickly in unnecessary numbers.

But, I’m sure if your local honcho has (unknown to the public) decided to close schools and bring all overflow pandemic ARDS cases to the local schools to be cared for in their final hours by unsuspecting local “emergency” volunteers, with no supplies, you can go do that. Let’s hope the planning on what to do with the bodies gets prepared better; but, last I checked, my municipal cemeteries’ handful of workers thought they didn’t need to prep.

Political illusions will pop like soap bubbles, no matter what people would like to believe, or say now, about, Pandemic may go away, or, may only be like the 1960′s, or, They better show up even without masks and isolation supplies and basic meds and electrity or else lose their licenses or go to jail! Their lives and their children’s lives may be at stake, and your sense of privilege is so out of luck anyway if we get an “unprecedented” virus gone pandemic.

If we’re both unarmed, I don’t say to the police officer, Get out there barehanded for the showdown with the gunslinger gang; it’s your duty! I say, Let’s live to fight another day.

Screaming for health care workers to promise business-as-normal isn’t going to give you normalcy during pandemic influenza.

The still-not-done individual, community, and overall health infrastructure preparation choices are the real problem and real issue.

A plan on paper that can’t be really be implemented is no plan.

Forcing all the health care workers to show up until they are all lost to disease or civil unrest or their own lack of sleep or whatever, is no plan.

Keeping the supply chain functioning for essentials, and keeping power plants and water running for the living is probably more important than caring for the sick, Dr. Nabarro has said, and that says something bad for the chances of the huge numbers of people getting sick; we’re just too numerous; 1918 medical conditions for everybody. Better to stock up, make plans for those who need help, self quarantine, and avoid the virus.

And the other preparations; Believe the worst may happen, and brainstorm now how to keep some essential -Volunteer- workers or retirees uninfected and running key services, buy stockpiles now, educate the public now,

that is what’s going to make or break society, not getting the health care workers chained up or forced at gunpoint to work.

Local officials and politicians are more afraid of their illusions for the public getting seen through now, than they are of really trying for the greatest good for the greatest number.

Perhaps they think afterwards, people won’t even know how much warning they had, and that they didn’t have any idea how bad it could get, but, I hope the surviving public isn’t all that uninformed, or that the ones who made the bad decisions not to educate the public don’t make it out of their bunkers. Humans have never had such warnings before of a bad influenza pandemic, and they’re blowing this chance by not wanting to take the political step to educate the public properly and stock up and prepare, and invest in our long-term health infrastructure.

So, Corky, have you volunteered for your local board of health yet? Serving on church/temple communities to deal with the emergency? Stockpiling for your neighbors? What exactly are you doing to help?

Grace,

Why do you list RN in your tag? Pay isn’t the only thing it’s about!

You don’t even want to know some of the things I’ve done as part of the job because it was necessary and had to be done right then. If peoples lives depended on getting a dose of radiation, I’d be first in line protection or not, I’m older and my kids are raised.

I guess one thing I haven’t made clear in all this is that I’m all for raising six kinds of hell now to get what ever you need, but that when it’s time I expect people to do the job they signed on for with whatever is at hand.

Melanie,

I’m on several lists, but the most likely to use me will be county fire control as they have the most widely varied group of tasks. I figure I’ll end up like last time moving from one job that needs doing to another. Two years ago I did everything from cleaning hoses to filling coffee cups and busing tables. Best job was dragging firemen who’d fallen asleep in their food off to a cot, happened way more than many people realize.

Corky 52-I am very apprecative of everything anyone does to help get ready for a pandemic.

Let me rephrase this-Would you want your kids go to work if they were told the equipment had become radioactive overnight, and their bosses had nothing to offer them for protection? Because alot of HCW’s are young, poorly paid, and have kids.

And re: Corky52 – at 22:34 “Melanie, No I won’t be at my office, because it’s at home”

It’s pretty safe for you then at work.

There is no place in the Respiratory Care Practice Act, the authority that grants my license in the State of Texas that requires me to provide care in a situation or environment that I believe is a threat to my well being. We are not soldiers. Soldiers are trained to kill and not get killed, from the very beginning of their training and most of the “don’t get killed, stupid” comes first. There is nothing in the American Association for Respiratory Care ethics code that requires me to endanger my self to provide care. There is nothing in my board certification as a RRT-NPS that requires it, and there is sure the shit nothing in my bank account that requires it. I have volunteered to work twice as long for half the money in the very front lines under HHS and the USPHS. USPHS are soldiers, of sorts; they are commissioned officers and have taken an oath. I am a civilian, but had to take the same oath of locality to the US, (I do solemnly sweat, that I will…etc). I said I took it without reservation or purpose of evasion. I am a civilian and I could quit today. Every American, North and Norhter, will have an opportunity to give something someone will need when we are in the DS. You people keep looking at us and seeing the Richard Scrushys and Dennis Kozlowskis and the HCAs and Kaiser Permanentes. I made my decision as a human being and not a HCW. Those who stay with their families have my support and will be needed in the end. The arm-chair quarterbacks and the Ontario Government can go fly a kite or worry about something else for a change. HCA may fold when this begins but healthcare will emerge in a form that do the most with what it has left. That is us, and we will be in larger numbers than the pessimistic and defeatist guesstimates I see here.

rrteacher – at 23:11

Bravo! and to crfullmoon, grace, and everyone else, even Corky who,i have not doubt, puts his money where his mouth is.

But I say, yet again, can someone show me where Ontario has actually passed this?

Another example is that of crews that performed cleanup after 9/11. I remember chiding someone on a board because “the air is not safe!!” She was concerned about air quality near her office. I quoted good old EPA telling us all was well, no harm in air pollutant levels. We all see how that turned out. Those workers should have had good respirators and protective clothing. Did they all have a place to decontaminate before they went home or back to an area where non-workers stayed?

I really don’t understand your high dudgeon, Corky. I believe that the pay for nurses is hardly a windfall at most facilities. There needs to be much more done to ensure the safety of HCWs, and I believe they have the right to demand that. I also believe that many will show up to do their job. If the mortality rate remains as high as it is now, we’ll be in a world of hurt with far less doctors and nurses to care for all the other health problems we have after the pandemic is long over.

“Why do you list RN in your tag? Pay isn’t the only thing it’s about!”

No, it’s sure not. It’s telling a mother on the phone to come to the ER quickly, but not to drive so fast she gets in a car accident. (Her child is dead) It’s telling a relative to please ask the doctor to have the patient moved to a hospital with trauma capacity, as you know no one else will. (true stories)

It’s crying your eyes out, but staying in the room with a 35 year old man as he holds his dying wife and tells her how much she has meant to him. true.

It’s working double after double due to nursing shortages, doing the right thing for the patient while getting shit on big-time by your boss and administration (oh, the stories I could tell). It’s taking alotta crap from families as you remind yourself it’s just the anger they can’t deal with. all true stories

It’s hoping the drug addict holding a chair and threatening to bash your brains in if you don’t get him drugs doesn’t do it…and you are working nights and are in the last room down the hall. (true story-he didn’t)

It’s reporting child abuse when the man who did it threatens to kill you. (true story)

It’s a whole lotta things, and each HCW here could write his/her own book. Not one of us started school thinking of the pay.

Corky,

The chip on your shoulder is showing. What’s up with that?

Grace RN,

Current job is landlord, I don’t figure to be collecting rents if this happens and I’m sure as he!! not planing on evicting people while something like this is happening, so no job to go to or worry about.

Corky,

Have you noticed that some of the biggest hearts on this board are the health care workers? Oh, you haven’t? Pity.

Corky 52- I am glad you will be kind and not evict people. Everyone will need a landlord who will consider the circumstances, WTSHTF.

In introducing the legislation in December, Community Safety and Correctional Services Minister Monte Kwinter said he wanted the bill passed by June.

This is all I can find. Getting back to the original point. Seems like it’s a proposal, not yet law.

Grace RN,

I’ve got good people in my buildings, would hate to lose them, besides most of them are friends to some degree. Occupied buildings are also safer than abandon ones. I just wish I could get more of them to pay attention to the flu threat!

I think most of the HCW are courageous and professional and will show up for work. If the government has to resort to conscripting the HCW, it would be an indication that the politicians, planners, administrators i.e. senior doctors, have failed to demonstrate their courage and leadership. I am not a HCW but as a citizen of Ontario, I remember vividly how SARS was handled and as I stated in another post on March 21st under ‘Canadian Preppers’, I don’t thing the Canadian leadership has learned anything. Note: trying to save money by buying cheap surgical masks for front-line workers, boosting confidence of public how good the Ontario Chicken Farmers are. Watch my word, more money will be paid to PR consulting firms on how to promote public confidence than buying the proper supplies and equipment. During SARS, the leadership spent their time and money promoting how safe Toronto is, and leaving the HCW to fend for themselves. I can understand the apprehension of ricewiki and maybe GraceRN. When TSHTF, the leadership who talked the most will just head for the hills. Just before leaving, they will legislate the front line workers to face the unknown with inadequate supplies, equipment and facilities. No one said the system is fair. That’s not even important. The important question is would the system work?

For me, that means prepare more for home care and self quarantine if my family gets sick, and don’t bother going to the hospital . It might as well be a morgue. Sadly, politically incorrect but true.

Doctors/nurses and other health care workers signed up to care for the sick and promote health. Does that mean that signing up could kill me? I can only hope that proper barriers/ID protocols are in place to protect me as I do what I do. It is quite difficult to judge the motives others have. Could I possibly blame a mother/physician who does not want to risk exposure to her baby at home? Could I speak ill of a nurse who stays at home to care for sick members of his/her family? Hardly. Caring for folks after the Tsunami in SE Asia exposed me to all kinds of nasty things and the amount of people I saw was overwhelming but that was my choice, my decision. No feather for my cap. Again, just doing what I do - can’t judge anyone who didn’t go. My only little supply of Tamiflu has been given away to a young doctor (27 year old)female) and I bought a box of N-95′s for her. She has made up her mind to stay the course, should pandemic arrive, should she not be protected? I think any anger at HCW’s may be just exposition of the powerlessness we all feel. The BF could be a giant and, quite frankly, the mother at home caring for family members may be more effective than the doc who needs 50 ventillators but only has 15 in the hospital. I won’t blame the water management fellow who doesn’t show up at work and must believe that HCW’s will show up in force if needed. Those that don’t have thier own reasons. I have enough difficulty walking in my own clogs without judging the motives of my peers.

I have been pro-active with my govern mentals here in Québec for three years now. I have embraced the back-up HCW plan and so did our gov in their public plan.

Here is Quebec Pandemic plan PDF English Version - http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2005/05-235-06a.pdf

Our culture is more consensual than coercitive.

We are focusing in recruiting retired HCW, we are forming volonteers, we are doing our best to support our HCW.

There are many retired HCW that do understand what is unfolding, and for personnal reasons are attending and ready to put the shoulder at the wheel.

There are religious group that for religious reasons are becoming pro-active and are learning from HCW what there will be able to do.

Many retired people from all expertises are ready to learn and give a hand.

When you add up all these people who understand the risk and are convinced that you just cannot let this fire burn without giving a little help, it brings in tens of thousands of people, it secure our HCW’s who have a sense of belonging to a society wider than their Professional Faculty.

None is fully convinced we are gonna succeed in this volontary recruitment, but each day a ‘Cavalery Wind’ swift our HCW’s, and generates a sense of belonging, a direction and a common interest.

Corky 52-

You see, we all have something we can give and something to care about. I’m sure a lot of landlords will try to get money or something else or try to evict those who can’t pay. I’m sure you don’t need some jerk-politician telling you you HAVE to let them stay because it’s in the landloards code. You will do it because it is the right thing to do. Maybe you can care for a Nurse’s family while she is at the hospital caring for your’s.

Asheville doc,

Pay it forward, indeed. It’s going to take community to get us through this because we are all going to have to do what seems best in our own eyes, and those of us with public roles to play are going to have to step up. That’s just the way it is.

There’s so much more about the ethics of a pandemic; we’re only touching the surface. I hope everyone will take the time at some point to read the links and ethics section supplied above.

Here is the link again. Go and read, ponder and contribute, here and there. Professional ethicists and moral theologians, feel free to get on board.

wow . . . I go away for a few hours, and there is a whole new uproar. Come on, guys . . . I was a teacher before I became a HCP (love that phrase), but the family tree boasts MDs, RNs, ambulance drivers (WWI, WWII) and one lonely deputy sheriff (my dad! ;-). I don’t know what I am missing here. I never saw it any other way—if someone needs my help, then it is incumbent on me to render it. I can’t choose to help you, but not him. I have to aid whoever is in need. No, I don’t want to die before my time, but, folks, lets face it, no one gets out of here alive. Be existential; define your life by your actions. I have been exposed to more *crap* than you want to hear about! And no, I am not a professional ethicist, but sometimes I do have to make those decisions on a daily basis. This is just my two cents, but then it is *my* two cents.

From the early beginings of H2H, we will certainly see a lot of confusion and key-stone cop prepping. Leaders will emerge from the front lines and rank/file HCPs, (I like HCSs [stiffs]). Perhaps we will get socialized medicine the hard way. In the deep end, money and prestige won’t get you a seat. Those in control, (it will largely be HCPs) will dispense what little we have to as many as possible. If ten die for everyone saved, it will be better than eleven. It will be less about CFR and more about character. How many die will be a footnote in history, but how we act will be our legacy. I’m with Jennifer. We will eat the same kind of crap we have been but we will be able to decide who sits at the table with us. We can practice as we were taught; to care for the sick and injured and do so in whole consideration to their needs. To every one in healthcare who wears a suit or has a private office, to all those who write the policies and the checks, to every seven-figure HC CEO, you can kiss us directly in the buttocks.

Jefiner,

That’ll teach you to go out for a few hours and miss what’s going on in Wikiland. Dem and I are hoping that a great thread on personal morality and professional ethics just got opened in time for church on Sunday/mincha on Saturday for our observing participants.

The ethics of a pandemic with limited treatment modalities, sick HCW, straightened food resources is a very complex discussion. We intend to have it here.

I have also just returned to see this developed thread. I appreciate the range of points made here. I must say I opened the thread from a somewhat black and white standpoint to begin with, as I was really standing behind my conviction. Usually I like to think I’m remaining or creating a more balanced view on things.

But when it comes to people’s lives… individual lives… no one has a claim on my or your life, regardless of what professional occupation or other institutionalized category we fall under. If you are like Jenifer and your occupation coincides with your own convictions and you choose to remain at work - great - that is important - but *you have chosen it*. It is this choice we must protect.

I also have some baggage with this issue of who has the “right” to “health care” as I’ve heard some pretty nasty stories about patient abuses of the health care system.

There is a difference between someone needing emergency care after a car accident or shooting, and someone needing dialysis because they continued to drink after already receiving two kidney transplants.

Finally, there should certainly be no “year in jail” fine “for every day!” of noncooperation?! Is this the Canadian government I hear? I completely do not recognize this language. (Maybe it’s the new Harper government.) Sure, feel free to look down upon workers who decide to stay home, but fining them? This amount? What?!! A nurse who chooses to stay at home rather than walk into a viral fire would end up serving more time than Colin Thatcher, who murdered his wife.

If you want to talk fines, how about fining smokers or anyone who needed bypass surgery due to an overeating problem? (I’m saying this to make an argument, not to make a caricature of the complexity involved in having an overeating problem).

I am not sure where this thread can go from here. It seems there are two grossly simplified camps of opinions: those who bind themselves to models based on external authority and law; and those who are concerned with a more humanistic, case-by-case ethics that supports self-governance and autonomy. One of these requires much less personal responsibility than the other.

Are we to believe in the last instance that the S.S. were just good citizens, “doing what they were told,” following orders, serving the Fatherland? The issue goes this deep, in my opinion. The problem has not disappeared.

Ah, it’s late… I’ll post this now.

The problem I have with this order is that the HCW are regarded as Cannon fodder, people who are regarded or treated as expendable in the face of enemy fire. It is not similar military draft or conscription. We will need these HCWs more than ever during and AFTER a pandemic, not waste them on a futile attack ordered by some ignorant politico who will hide away in the secure NBC bunkers somewhere.

Let’s remember that this is a bill in the Ontario Legislative Assembly, not a passed law. Let’s be a little more circumspect about how the law works in our various jurisdictions. This is a proposal, not a law.

Melanie - I just read you signed up to become an EMT. I’m so damn proud of you. You brought a tear to the eye of this old medic. Thank you, from the bottom of my heart. :)

As to the rest of the discussion, it is far more complex than just expecting HCW’s to show up. A hospital isn’t just made up of Doctors and Nurses and RT’s. In order to run, the cafeteria workers, housekeeping, security, orderlies, nurses aids, and volunteers need to show up, too.

Now I ask you, did any of these employees take an oath? Are these people making a killing off health care with their minimum wage jobs? And can hospitals function without them?

On any given day, in the US, there are between 800,000 and 900,000 people in hospital beds. Another 1.8 million reside in long care nursing facilities. Additionally, hundreds of thousands of people show up at Emergency rooms each day, some with life threatening conditions.

Unless we find a way to keep these facilities functioning, these are the first 3 million casualties of a pandemic. And none of them need contract the flu to come to a bad end. Neglect and abandonment would kill millions.

While I’ve no doubt that politicians in some places will try to legislate mandetory work attendence, and not only in health care facilities, I can’t see this working. An employee need only call in and complain of a fever, and they will be exempt from work. And who really wants a scared, unmotivated, and highly resentful caregiver who shows up under duress? Sounds like a disaster to me.

Corky I applaud your volunteerism. And when I was 20, and a young medic, I probably would have been appalled at the idea that HCW’s might fail to show during a pandemic. The idea never would have occured to me. But that was a different time, and Health Care is not what it used to be. Sad, but true.

While this is seemingly an impossible situation, it really isn’t.

The answer lies in what Melanie, Grace, Jefiner, rrteacher, Corky (and lot’s of others) will do, come a pandemic. They will realize that everyone is an essential worker in a crisis. And they will, for reasons of duty, honor, or simple survival, rise to the occasion.

Will it be enough? That depends on the goal. If `enough’ means that we save every life that could be saved, or that we somehow beat back a pandemic from our door. Then no, it won’t be enough. Not even close.

But it will be something.

The hardest lesson a medic learns is: You can’t save them all.

But you can save some. And in the end, that’s better than doing nothing.

To those who say “It isn’t my job”, but still expect others to do it, I would say: When the river is rising, everyone can fill a sandbag. You don’t have to be medically trained to help feed patients in a nursing home, or to volunteer at a hospital, or to drive a truck to deliver medicine, or to pick up the dead.

And while hospitals will be overrun, and may end up looking like the Superdome after Katrina, there are better ways to provide health care during a crisis. Nurses and doctors and medics who will service their neighborhoods, make house calls, or set up ad hoc treatment centers.

The ONLY way I can see to mitigate the effects of a pandemic is for ordinary people to do extraordiary things. The Federal government can’t save us. And neither can the hospitals or public health department. They were never set up to handle a pandemic, and never will be.

The ultimate survivalism is working as a community. I know that goes down hard for some folks, and some may even feel threatened by the concept. But in the end, that’s what it boils down to. Lone wolves rarely make it in a crisis.

Hopefully we have some time to prepare. To make mid-course corrections in the system. Stockpile necessary items. And develop a plan (which will be discarded in the first hours of a pandemic <g>). And we should use this time wisely.

While we can argue over what should have been done, look for entities to blame, and wring our hands, none of that will serve us once a pandemic begins. We will be stuck with the situation at hand, and must learn to make do.

In some ways, I view a pandemic like a final exam. It will count for more than 50% of our grade. We pass or fail as a society based on how well we do.

I’m still enough of an optimist to believe we can pass this test. It won’t be pretty, and our grade may be marginal, but I still have faith that when the chips are down, a lot of people will step up to the plate.

But then, I buy lotto tickets too. <g>

Melanie,Fla_Medic,rrteacher et al-thank you. Consensual instead of coercive is the way to plan. Plan ahead, then work together.

Corky 52-A landlord who teaches his renters about the risks of panflu and then lets them stay when they can’t pay the rent will be just as important as the people who show up for work elsewhere.

All aspects of community will need to pitch in, each one bringing something to the table in order for as many as possible to get through this. As Fla_medic put it so well- you can’t save everyone (sad, but true). But you try to save as many as possible. The unspoken credo.

Fla Medic-From now on, I’m sending you all my notes and you can speak for both of us.

What can we do now to assure the best of what we have and sacrifices we are willing to make are not in vain?

Prepare ourselves first. The ridicule is lessening as more MSM and “Holy FS” comes from the mouths of experts. We continue to leave articles and “flu”flyers” around and even when the non-believer reads them and guffaws in a wing flapping hoot, they will remember what they read. When that momentum gets a little more roll to it, we petition our professional leaders to preempt the PTBs with certain demands and considerations as a contingent for our cooperation, that:

These transparent rules of engagement for healthcare workers receive endorsement from our professional organizations, the AMA, ANA, AARC and Canadian counterparts.

B: There is trusted (by us) medical leadership in the chain of command and decision making.

C: There is reasonable protection for HCWs (HCPs) and a reasonable “exemption” status for those who cannot take the risk or cannot abandon their role as family caretakers. There will be a vast array of tasks and services that could be supported by these reserves.

D: We reserve the right to refuse to perform any duty that is ethically or morally wrong. Ethical and moral nova-norms should be spelled out early. If you change them, you better have a good convincing story.

I have to work, and with a few exceptions, under the direction of a licensed physician. MBAs and JDs can sit in the waiting room, because I will decide how to do my job.

We need someone who can organize this on a national scale and act as a spokesperson for HCPs. If HCPs get behind the idea in large numbers, that will be the power we need. Keeping us in the dark til TSHTF is a way to keep us from getting organized and demanding all this unreasonable stuff, right?

Unless someone says, “gee Richard, that’s really lame”, I am going to run this by Mike Osterholm.

Fla_Medic - excellent post! It will be all the “cogs in the wheel” that make or break this situation.

A pandemic situation is unlike any we have typically encountered. There have been times in my career where we were unsure of how to protect the HCWs. Think of AIDS, SARS. But in this situation, in all liklihood, we will NOT have the means to protect HCWs. No vaccine, no definitive treatment for patients, perhaps no protective gear (lack of proper masks/respirators, lack of occlusive eye protection, lack of supplies like meds, IVs, gloves as transportation fails, lack of ventilators, etc).

In the work setting, HCWs can refuse to perform a task that is deemed unsafe or unethical, etc. It requires a lot of political wrangling to do so, but it is an option. Some refuse to work in areas that perform abortions, some refuse to give massive doses of narcotics, some refused to care for AIDS patients when it all started. We work around these situations and resolve these conflicts routinely.

THIS situation will be unique. Again, a new paradigm. Expecting care from workers without the tools to do the job is unacceptable IMO. But what will we do? I think of trying to care for an Ebola patient without protective gear. Would I do so? No. That would be suicide. And would result in at least 2 deaths, not one.

Those getting sick now, may be the luckiest. At least they will have the benefit of supplies and equipment. This will NOT be the scenario if this turns pandemic. So we are only speculating on a situation that we can not even imagine. I assume that hospital workers would get quarantined on site anyway once panflu patients are confirmed. I know I can’t envision driving to work alone during a mass hysteria situation.

I have been thinking about the utilization of our HCWs. I am not so sure we should send everyone to the forefront at once. Perhaps work in groups for extended periods of time, like 2 - 4 weeks at a time. I can’t see workers caring for panflu patients and then going home anyway. Perhaps they will work directly with patients, then move them to another location that is still helping, but not with direct patient care. Then send them home and/or allow them to work at another facility that does not have flu victims. I would like to see a tiered response for workers. Preplanned. Pre-arranged. Those who agree to work first wave, second wave, etc.

Working without the tools to protect the worker is ludicrous. Otherwise, we just expose healthy workers to sure infection, thus losing the skills we will need post event. And if we don’t have those tools, then the only logical solution is to focus on prevention. While the “brains” focus on a cure/vaccine.

rrteacher – at 09:46

Very good idea. The Ontario studies provied have some great historical background and due diligence, for those who want to take this further.

If the hospital provides me with proper personal protection gear and Tamaflu then I’m probably in. If not, I’m out. I’m sorry, you cannot expect me to go into a contaminated site without the proper gear. That’s not asking too much. I feel even more strongly about this when I see the seemingly lack of concern/preparation on the part of my hospital. They don’t seem too concerned about preparing for a pandemic. I’m sure it’s very expensive to stockpile PPEs (my opinion). Well, hello, it’s my butt that will be there on the front line in the ER risking my life and the lives of my family while the “bean counters” and CEO’s are tucked safely at home.

All I ask is to give me the proper gear to perform my job safely. Otherwise, if I’m going to do a suicide mission, it will be to care for my family, friends and loved ones.

DebMcRN – at 10:53

That’s a reasonable expectation. The Ontarians have defined this as ‘reciprocity’. Whereas HCW/HCP have obligations, so, too does the employer and administration. You’ve summed up the issue in a real and concrete way.

I totally agree with you DEB,

I am a nursing aide in an Ontario LTC facility. My city has planned in the event of a pandemic, that family shall when able take their loved ones home with them so our facility can be used as an emergency hospital.

The only preparation my facility has given its workers- how to properly wear a N95 mask.

With this valuable training, I plan to use it to care for my family.

It has been interesting to observe the different participants of the forum—some plan to retreat to the fortress, some (like me LOL!) develop endless lists for supplies, plans of action and so forth, some seek, ad nauseum, to blame Big Gubment, Big Bizness, Big Healthcare for all the problems now and to come—kind of like blaming George Bush for the Tsunami. I think a lot of this is the result of anxiety—if you do something, anything, then you are taking control of a situation. Except, this situation is uncontrollable. When the pandemic comes—if it comes (and I do think it is coming), it is going to wash over us just like the tsunami, and then who knows if our plans will work? Hopefully they will. But in the middle of all the chaos, disorganization and death people will either rise to the occasion or not. I believe that most will do what they can to help when called upon, either out of dedication, good intentions, or just the simple relief of directing frustration and energy into purposeful activity.

My dedication, good intentions, and purposeful activity will be directed where *I* feel it belongs….to my children. When I became a mother I became commited to protecting them FIRST….when I became a nurse, I became commited to helping others, but not sacrificing my life (or my childrens) in doing so. The only hero that I need to be is in their eyes. Do I feel confident that I will have the proper resources and protective gear…..hell no! If I can help in anyway that will not directly put my children in harm’s way then I’m all for it…..othewise I’m staying where I belong.

anonymous at 11:23. Good, then. Attend to your family. I have a family as well, and I am worried about what will happen. I would just encourage everyone to think about this without taking this as an ad hominem comment. If HCWs choose not to work, then who will be there to help them in their hour of need?

and if all HCWs choose *to* work, who will be there to care for them when it’s all over and done? Won’t be many left, imo. Unfortunately, it is my belief that there will not be much we can do to help anyway, with the resources that will be available.

Jefiner,

I agree about the ad hominem comments.

And if there is a dirth of HCWs, then who will be the caregivers?

When you think about this situation, if there is a lack of treatment, supplies, food, etc. in the hospitals as well as a lack of providers (either due to being AWOL or being ill themselves or DEAD), then just what good will it do to be admitted into the hospital in the midst of a pandemic? Just a storage area? And who is going to get you there? Emergency medical personnel are going to be sick and dying also.

There won’t be any better treatment in an unstaffed and unprepared hospital than at home. Unless we magically get personnel, supplies, meds, equipment that logistically, I don’t see happening. We already have a shortage of HCPs - TODAY. We will have a shortage of supplies in days to weeks. We will have a shortage of ventilators in days. We have no vaccine, no current treatment. We will be reduced to providing home care in a hospital setting. The one problem with that, is as everyone in healthcare knows, is that a hospital is the last place you want to be if you want to avoid infection.

Having knowledge in basic first aid and infection control at the homefront is essential, IMO.

There are so many different angles to consider. Are you willing to put your life and your family’s life on the line to work? If you do decide to take the risk, what happens if your spouse/children fall ill? Are you going to leave them at home to attend to others? What if you get a call that your parents in another state fall ill? Are you going to attend to others or go care for them?

In my mind, I’ve decided that I will go to work if I am given the proper gear and feels protected. I will not go on a suicide mission. And, if my loved ones become infected and need me, they are my top priority. I will care for them. Ethically, I don’t think that is wrong.

Exactly why we need to be figuring all this out ahead of time! For example, anonymous at 11:23 would you consider taking in an elderly person or extra children for the duration so that someone else can work without worrying who will care for their family? Then that person works for both of you. I have no idea what sensible preparation would be here, but I do know we need some good creative problem solving (ahead of time) without trying to make people feel bad about their decisions- or bail out at the last minute.

exactly.. it’s vital to ahve discussions like this one and this one(Adopt a Vital Worker) in advance.

And it’s, of course, not just HCW/HCP. It’s cops, firemen, clergy and morticians.

Lets talk ethics As i speak hospitals are spending money on advertisments touting the superior care they give, engaging in expensive expansions ect…. What they are not doing is stockpiling PPEs [to expensive] If we do have a pandemic you can bet your bottom dollar that a study will be touted stating that surgical masks are as effective as N95 masks. BULLS***T Every HCW will know that it is BULL***T. I wont even go into providing Tamiflu for HCW who are working on the frontlines - we will just be allowed to drown in our own secretions. I have no obligation ethicial or otherwise to become cannon fodder because of someones bottom line. If this society cares so little for the lives of HCW then so be it -we are not going to be there when were needed very few of us are sucicidial. I believe that a survey was done in NY regarding terrorism diasters ect. and lastly the Avian flu. HCW in large numbers would show up for a terrorist attack and diasters. But when faced with a pandemic flu the numbers flipped dramaticially I believe 66% of docs and nurses said they would not show up. So assuming that when the time comes most of us will suddenly become sucidial and show up to stand by and hold hands of the dieing is fool hardy. We will not have the supplies needed to give even basic care. Oh did I mention that those same bean counters who are spending all that money on ads and expansion are also not stocking any extra supplies to treat you. Patients cannot be treated by magicwands. A lack of Vents is the least of the problems we are going to face. I will be providing whatever tx I can in my own nieghborhood, I have bought my own masks for this purpose. I will phone triage in my township but I will not under any circumstances go into a situation without proper PPEs Want my liecence - take it I can get a job making far more money with better working conditions anytime matter of fact I have had such jobs -but I came back to nursing foolish me. How dare anyone who isnt in the HC feild state that we have garnered the monentary benefits and now its time to pony up for all the wonderful benefits weve enjoyed. What a crock. Bottom line no PPEs no work society will just have to pay the price for its priorities when the time comes. Scream holler threaten all you want their is no threat as bad as drowning in your own secretions. Conscripting HCW is going to be a nightmare - ever heard the saying you can lead a horse towater.

Great idea kc. I would be more than happy to care for someone else’s family. Now, if only my coworkers would sit down with me and seriously come up with a plan for doing this…unfortunately, they all (so far) think I need to be committed when it comes to this topic.

Janetn - Great post…..you took the words right out of my mouth!

Health care workers’ ability and willingness to report to duty during catastrophic disasters. See this wiki page on HCW Safety. it’s an issue we care passionately about.

Anony-mouses (?anony-mice) pick a screen name and join the conversation. ;-)

Ok…..I was tempted to make it anony-mouse though. I like that lol!

MamaBear – at 14:38

welcome. This is not the only important topic, but it’s one of the most important topics we can discuss.

Janetn at 13:47

This is what I was talking about—it’s the government-business-hospitals-military/industrial complex’s fault. Look, whether we like it or not, we live in a society that has both requirements and benefits for us—this is the social contract. Somehow, this contract has been reduced to a cafeteria line—I’ll take the fire and police protection, but I’m not going to help out if I am asked. I understand that we all have family obligations; I don’t think anyone in this forum thinks we should abandon those who need us, especially if we are nursing or rehabilitating ill family members (or ourselves for that matter!) All I can say is that I, personally, feel it is my obligation to respond to help if asked. I currently work in home health and in a hospital setting; just recently I had my rear window blown out while I was driving by some little gang banger going through his initiation ritual. The round missed my head by only a couple of inches. I was thoroughly rattled by the experience, and DH wanted me to quit my job. I didn’t, because I believe my patients need me. That is just one of the threats HCW currently face; lets add in TB, pneumonia, VRE, necrotizing fasciitis and a whole host of nasties that await the unprepared. Hence my own stash of PPE, which is better than what is supplied by my employers. We live in danger every day, whether from disease, crime, war or natural disaster. The only protection we will ever truly have is if we hold together in some kind of social structure—tribes, if you must—that will maintain order. As Mr. Franklin so eloquently said “If we don’t hand together, we shall all hang separately.” Gotta hold on to the social contract!

uhhhh “hang together” PIMF!

We also do not ask our police or fire fighters to go into a situation unarmed or without equipment. Accepting the everyday dangers that we face is one thing. We know we will take care of patients with TB, HIV, etc. We know if we do home care we probably will have to go to dangerous neighborhoods…..all of that is far different than walking into a suicide mission. Just out of curiosity…do you have small children at home? and are you ok with leaving someone else to care for them? If so, fine. You are entitled to your opinion just as I am mine. Obviously, your priorities and moral obligations are different than mine…it does not make your choice any better, or worse than mine.

I see how HCW’s are treated now…without a pandemic. We work short handed every day of the week. Patients are lined up in the hallways, nurses are assigned an impossible number of patients and are fully expected to “do no harm”. We work 12 hour shifts, usually without a break and are lucky if we get a chance to go pee. If you’re sick, you’re still expected to come to work (unless you’re dying) and when you’re there you better not slack off because the other nurses are so overwhelmed, they can’t pick up your slack. There are ridiculous policies and busy work created by TPTB that are clueless. It is sooooo obvious that we are only numbers to our employers, nothing more. We fill in a slot on the schedule. Can you see why we may feel resentful when it comes down to our willingness to put our life on the line (and that of our family)? My hospital doesn’t care enough about me or my coworkers now to stockpile or formulate a plan for a pandemic. So how can they expect my loyality?

Don’t get me wrong, the reason I put up with the crap that the hospitals dish out is because of the patients. I have excellent clinical skills and I try to put on blinders regarding “the institution” and try to focus on patient care. That’s what I am, a nurse. But, if the hospital cannot/will not provide me with a reasonably safe work environment then I will not be there. I promise you that the majority of the nurses that I’ve discussed this with do not plan to go to work. That sucks for the community. I’ll be there for my friends and neighbors.

“Surge capacity”. I’ve heard there’s this idea to send “non urgent cases” home. You want a hip replacement? Go home. Disc herniation? Go home. Those are just painful conditions. We need room for potentially deadly conditions, and you don’t want to stay here, do you?

This happens where hospitals are a public service. Same where that’s not the case?

To MamaBear at 17:07

Ahhh, the children question; this one issue is almost always bound to raise emotions. And I am curious why you would even ask? Would it matter if I did? Did not? Had old people to take care of? In a committed homosexual relationship? With a paraplegic dominatrix? Or the obedient servant of two unruly Labradors? What your question is really saying is that you are justifying your stance because you are a mother. Fine. The obverse of your question implies that A. if I did have small children at home, and felt the way I do, then somehow, I would not be a good mother, or B. I only feel the way I do because I do not have small children at home, and am free of any burden of responsibility.

As I noted above, if this is your belief, then by all means, attend to your family. They (assuming they survive) are our future. You pays your money, you takes your chances. I land on the position I have chosen,and I will live with that. But let me throw this thought out there for my fellow wikis: have you thought about what you would do if your children/spouse/parents/family die? What if this thing is even greater than the Black Death, and we do lose >50% of the population? What if all the preps, chicken soup, tamiflu and tylenol fail? There are a lot of people on this board thinking about that as well.

(Parenthetically, 45 y. o. female, married, one son in the United States Navy, *and* obedient servant to two unruly Labradors that I am now watching swim in the above ground water supply my husband calls a swimming pool :-)

DebMcRN – at 17:40

I agree—our hospitals are currently understaffed; I don’t see the supply issue right now, but it would only take a couple of days to burn through what we have. I watched the current flu rip through Phoenix this winter. One hospital actually closed its doors because there was literally no place to put patients—I saw patients on gurneys in the corporate boardroom, and the CEO of the hospital was on poop patrol. (So much for the concept that they don’t care about us peons.) That hospital is now being investigated by the state—someone told me that there may be criminal charges—because by closing doors, they turned patients away. Another hospital was triaging patients in the parking lot with police protection. Heart attack? Into the hospital ER. Flu? Over here to this tent for IV’s, Tylenol and soup. It was ugly, but it worked, kind of. One problem we have here in the south west is that both our winter visitors and illegal alien population have developed the habit of using the ER as their primary source of medical care for even the most mundane of situtations (getting an MD to write an rx for lipitor), so it doesn’t take much to swamp an Arizona ER.

And I understand why the need for PPE to be in place far in advance. As I noted above, I carry my own stash. But even with the best of preparations, we are going to run out of things, which will force all of us to be creative in how we use PPE—face it, folks, we may be doing without for a very long time. I know health care is a business, with all the attendant requirements for marketing, shareholders and bottom line. But if we don’t expand bed space, there will be no room for patients. And marketing makes money for the hospital. And the last time I checked, I work for my patients *and* for the paycheck too. Helps to buy preps! Render unto Caesar and all that.

I am not *justifying* my stance at all..there is no need to. I am taking my stance because of being a mother. I ask the question of you because maybe you would feel differently if you did have small children at home that needed you. Just as mine would most definately be different if I did not. I would never imply that someone was not a good mother for choosing a different option, just as someone else should not imply that I’m not a good person, in general, for my choice. I know very well that if this “thing” stays as deadly as it is now, there is a very good chance that we may not survive…but I would rather die with them then have them die alone. So…let’s just agree to disagree here. I respect your choice, for your reasons and I would hope that you can respect my choice for my reasons.

MamaBear – at 18:40

As I noted above, I can only control what I do, not what you do, my neighbor does, or anyone else for that matter. There is no value judgement there/hence no disagreement. You do what you need to do.

As Dem noted earlier, this is one of the most important threads that the forum has ever hosted. I hope all of the “lay” (i.e., non health care workers) participants are getting a sense of how complex this calculation is for those the the health care professions. This is not an easy discussion. It has also revealed exactly how fragile our system is, discussed by the very workers who have to deal with that system every day.

Indeed, Melanie.

And no matter what side of this arguement a health care worker comes down on, thier decision is not an easy one. Deciding not to work, for the sake of one’s family, could well be harder to do than deciding to go into work.

I make no judgements on others in this issue. Each person has their own unique circumstances to deal with.

Our focus should be on enabling those who can work, to do so with the most safety and effectiveness possible. Nothing is gained by attacking those who find themselves unable, due to personal circumstance, to participate.

And many who will not go into hospitals to work, may well find other ways to help. No contribution is without value.

rrteacher’s suggestions earlier in the day, I feel, have a lot of merit. We need a code, or policy, that protects HCW’s. A covenant with the Powers that Be.

I’d like to see us work on that, and other solutions to the problems at hand. Practical solutions, like using hotels for temporary barracks for HCW’s so they don’t infect their families. Workable shifts, with adequate decompression time, so that we don’t burn out those who are on the front lines. Comm setups, so workers who are separated from their families can stay in contact with loved ones. And an adopt an essential worker’s family program, so that people can work and know their families are being looked after.

The devil is in the details. And this seems the appropriate place to discuss them.

Fla Medic The detail is no PPEs nobody wants to own up to the fact that as we speak money is being spent on other things [unnessasary things] But PPEs are deemed to expensive to stock and therefore are not being stockopiled at this very moment. HCW lives are therefore deemed disposable. Society will reap what it sows. Public beware when the time comes for a HCW better bring your own.

We put up with more crap on a day to day basis then most of you laypeople imagine, but there is a limit, and forcing us to work without adaquate protection when there has been plenty of warning is unexceptable. Any of you laypeople who think otherwise go volenteer at one of the off sites during the pandemic - put your money where your mouth is. Your ass capable as I am to fluff a pillow or hold a hand - thats all were gonna be able to do when the supplies run out. All these off site facilities are going to be are holding sites for the dead and dying. no nursing care is going to be given

I have contacted my senators reprsentitives both state and federal and I have contacted the governor of Michigan - so far nothing. I ask you do the same - at least then you can say you tried.

Janetn - I knew I liked you……and from Michigan too!!

The bitter ‘no one is doing squat’ is actually not quite so. Some hospitals are stockpiling PPE and portable emergency vents (run on oxygen). Some hospital HR units are reviewing their well and sick poliicies. For whatever good it will do.

As we talk to people around the country, we find different levels of preparation going on. Not adequate anywhere, but some are doing better than others. This stuff takes time. It’s time we hope we have.

just try to imagine what it will feel like when all this is over,..You as a healtcare worker isolated and was safe, then you encounter friends, families, colleges etc, who all have lost someone they loved.. Try to look them in the eyes and say you chikkened out.. No I dont think healtcare workers will do that..

It’s NOT about “chickening out”. I feel no shame in my decision and, God forbid, I may just as likely have lost loved ones too! I take it you’re going to volunteer?????

Mamabear seems were kindred souls where are you in MI. Wanna rattle some cages in the state with me? Im sure we could get some politicians rattled. We could get some of our coworkers to join us too - the ol strength in numbers thing - a election is looming ya know

JaneTn, I understand your frustration with the system. I share your outrage. And no, I don’t believe we should force anyone to work during a pandemic, even if PPE’s are provided.

But you are correct, the first step is to make sure that the basics are covered. Masks, gowns, gloves. Tamiflu if it is proven to be effective.

But beyond that, we need to be thinking about whether flu patients should even be treated in a hospital setting. Radical? Perhaps, but excluding flu patients from the hospitals may be the only way to save the health care system.

Come a pandemic, hospitals could end up looking like the superdome 4 days after Katrina. In that case, no one will get any care. Need a C-section? Tough. Having chest pains? Can’t help you. Bowel obstruction? Sorry, come back in a year.

We seriously need to consider if a policy of triage should be in place, where all flu victims are met in the parking lot, and sent home. Or perhaps to ad hoc flu treatment centers set up in gynasiums or community centers for those who have no families to care for them.

Would it work? I don’t know. Certainly, some asymtomatic flu patients would get in with other complaints. We’d need to identify them as quickly as possible, and move them out before they infected the whole place. Maybe it fails, but it’s worth trying.

But the reality is, there is not much we can do for flu patients, and so the best thing we can do is preserve the system for those we can help.

For anyone who thinks this is heartless, I can assure you, it isn’t. Probably 90% of flu patients would never see the inside of a hospital during a pandemic anyway. The only difference here is, the 10% who might have gained entry, won’t be allowed to destroy medical care for everyone else.

Adopting such a measure would also greatly protect health care workers, making it possible for more of them to continue to work.

If I catch the flu from a patient I’m treating, I’ll go home and ride it out. I wouldn’t want to be in a hospital, anyway. Nothing they are going to be able to do for me there except provide me with a complementary nosocomial infection as a reward for chosing their facility.

Triage means saving those who can be saved, and not wasting precious resources on those who cannot. There isn’t a hospital in the country that could double its census with flu victims, and survive.

Will our leaders have the political will to do such a thing? I hope so. As abhorent as it sounds, it’s better than the alternative. But that decision needs to be made now, before the hospitals are overrun, if it is to be effective.

Urdar NO,

Every one is going to have to make difficult ethical decisions if TSHTF. I find your condemnation to be unwarranted. Until you know everything about the situation of the person involved, you don’t have any information to pass judgement. That was uncalled for in a forum such as this.

Flamedic I understand the need to preserve hospitals for the usual emergency patient population. But how kind is it to send people to what effectivly will be nightmarish wharehouses. You know that nothing approaching care will be available. These off site centers are designed to do nothing but placate the public. They are gonna be calling for heads when they find out theres no plan to treat the sick -and that it was for lack of money nobody planned for adaquate supplies.

If I or a loved one contracted the BF I would not want to be in one of these hellholes - and thats what they are going to be. Katrina will seem like a fourth of July picnic. Remember the pts of Charity Hospital, what about those who days after the leve break were left laying on army litters in the airport? That was a local diaster. Think what school gym would be like during a pandemic? Hell would be kinder. If they powers that be will not get adaquate supplies it better that they not even open these sites. For those that have nobody to care for them bed space could be found in long term care facilities their numbers are not that high. Again these sites in gyms and the like are a public realations stunt to make it look as though the politicians have done something for the masses when in fact they have not.

Fla_Medic, If I am provided with the proper PPE and worked during the pandemic, there are several issues/concerns/questions I would have. First, the actual work would be exhausting because of the volume of patients and having to work 12–16 hours in PPEs. To wear a mask for 12–16 hours is necessary but smothering and extremely uncomfortable. Will we be able to decontaminate when leaving the hospital (shower/decom room)? If so, would we be able to safely go home or would we have to stay in a barracks/hotel? It makes sense to work muliple days in a row, decontaminate, and go home for a stretch. If quarantined in the hospital, will we have food and supplies for the staff, as well as the patients? Will the hospital guarantee Tamiflu or advanced care for a sick nurse?

I like the idea of using hotels/tent cities as additional hospital rooms that can be manned by volunteers and/or medical staff for flu. Save the hospitals for the cardiacs, strokes, accidents, etc. Also, an extensive home health network. Send HCWs to the homes. Nurse hotlines for advise. Some sort of network where doctors can work with pharmacies to get prescriptions out to patients at home. Pharmacy deliveries by volunteers.

Another concern is legal. If, as a nurse, I am caring for patients outside of a hospital environment, acting on my own and not under the guidance of a physician ,caring for neighbors and friends, would I be covered under the Good Samaritan Act?

Janetn, I’ve no illusions about what conditions would be like in an ad hoc setting. The only place to be, if you have the flu, is home in your own bed.

But I also know we have a problem with `dumpitis’, aka `the pop drop’. There will be patients left on the doorsteps of ER’s around the country. There are hundreds of thousands of homeless who have no place else to go.

Could long term care facilities be used? Perhaps. But then, you need personnel to run them. And you’d be introducing highly infectious patients into a mix of elderly and medically fragile patients.

An ad hoc flu receiving center would be a hell hole. No doubt about it. Certainly not a place I’d want to be. Their only advantage is that the dying would be gathered in one central location, allowing for more efficient removal of the bodies.

And I agree, the PTB are going to be so late to the party, most of the solutions are going to be horribly inadequate.

But we can only play the hand we are dealt. Maybe the next pandemic, we’ll be better prepared.

My biggest concern is preserving that which can be preserved. And I include the lives of the HCW’s and their families in that equation. These people are my colleagues, my friends, and my extended families.

I don’t profess to have the answers. But I’m looking for them.

How about placing the care of the flu-ridden-and-still-alive in out-of-hospital locations (as someone above suggested) and in the hands of adequately trained volunteers?

In Woodson’s book “Bird Flu Preparedness Guide” he says that the most this care will really amount to is to ensure the patient has a steady supply of liquid going thru the system and then to keep track of all that on a chart.

We don’t need RN’s to do just that.

In the name of preparedness, communities could train volunteers (as they train volunteer firefighters) for just such a pandemic flu situation. This way, there is a greater pool of people to draw from and their deaths (for many of them would surely also die) won’t mean the loss of years of specialized training and education (as it would with nurses and doctors). Society will need the specialists afterwards, and it takes years to produce a good specialist.

(just in keeping with the strong utilitarianist impulse of much of this “service” mentality).

Flu medic are you willing to sacrifice HCW to staff these dumping grounds? most long term facilities have bed space, and there is usually more than one in an area transfering existing pts to free up a facility would be at least an option. At least these facilities have some supplies as well as O2 concentrators. As far as staffing well ther you go again shoould HCWs die to wharehouse in abominable conditions. Why not legislate fines for dumping pts - that should at least cut the numbers down. If society is willing to jail HCW they should be willing to jail those who abandon their own family members? Ethics should apply all around I quess. Society has gotten used to dumping grandma off at the local nursing home transfering responsability is this societies way of life - someone else clean up the mess. But make sure its cleaned up

I wonder how many lay people here are going to risk death by volenteering to care for ther sick? Bet it isnt many.

DebMcRn, every state has a good samaratan act. Basically, as long as you are providing reasonable care, with no intent to cause harm, you are covered. Regardless of patient outcome.

You bring up great points.

Burn out is real. In a pandemic, it will be like working a war zone. We need to find ways to rotate personnel to give them decompression time. And fatigue is a killer. Both to the HCW, and their patients.

I could see working 4 days on (8–12 hour days), and then having 4 days off. Something like that. Enough time to recouperate. Maybe divide each 24 hour day into 2 6-hour shifts, to avoid having to wear the PPE’s for too long a time. Need to find an optimum schedule, that gives enough rest time between shifts.

Set up a motel or hotel near the hospital as temporary living quarters for the HCW’s. I doubt the hotel business will be thriving during a pandemic, anyway.

If we setup ad hoc tent hospitals, or in community centers, family members of flu victims could be dragooned into doing a lot of the work, under the supervision of HCW’s. It won’t be pretty, but it could work under some circumstances.

But the main focus needs to be on home health care for flu victims. No ad hoc facility is going to provide any standard of care you or I’d want to receive. Best to setup help lines, have volunteers visit homes, and keep the hospitals safe and sane for those with medical problems other than the flu.

Tamiflu, IMHO, should be made available to HCW’s who want it prophylactically, and certainly for any who contract the disease. And I think some facility could be setup for HCW’s who contract the flu, if they don’t want to ride it out at home.

There should be incentives for people to risk their lives. Carrots, not sticks.

Janetn, if you’ve got better ideas, I’m listening. I’m certainly not enamoured with the ones I’ve come up with.

ricewiki has it right. Train volunteers now! If the medical community does not, they will be in the “Hell hole” alone. I keep hearing, “you just don’t understand how busy medical professionals are.” Well, it’s about to get busier. There is a solution, no one is listening. I’m not going to jump into a highly infectious situation with no training. I’ll stay home and keep my family safe. If the local medical community sets up a training course and tells me how to remain safe and helps set up infirmaries that have a chance of doing the job, I’ll be there to help them. If they choose to remain silent and this hits soon, they screwed themselves. Doctors could put this threat on the public radar tomorrow, if they changed their “unified” message to, prepare for a pandemic, we will help you.

Fla_Medic - I could very well be wrong, but I think I remember a discussion in nursing school regarding the Good Samaritan Law. A question came up about stopping to help at an accident scene and whether or not you could be sued for the care you give in that situation (as an RN) and I thought the instructor said that if you identify yourself as a nurse at the scene then the GS law will not cover you because you are not just a lay person offering help and you “should” know what you’re doing….not 100% positive on this though…I’ll have to look it up.

From Wikipedia - I’ve checked other sources, and they seem to concur. <g>

Though the details of Good Samaritan laws in various jurisdictions vary, some features are common: General guidelines

1. Unless a caretaker relationship (such as a parent-child or doctor-patient relationship) exists prior to the illness or injury, or the “Good Samaritan” is responsible for the existence of the illness or injury, no person is required to give aid of any sort to a victim.

2. Any first aid provided must not be in exchange for any reward or financial compensation. As a result, medical professionals are typically not protected by Good Samaritan laws when performing first aid in connection with their employment.

3. If aid begins, the responder must not leave the scene until:

• It is necessary in order to call for needed medical assistance.
• Somebody of equal or higher training arrives to take over.
• Continuing to give aid is unsafe (this can be as simple as a lack of adequate protection against potential diseases, such as latex gloves to protect against HIV) — a responder can never be forced to put himself or herself in danger to aid another person.

4. The responder is not legally liable for the death, disfigurement or disability of the victim as long as the responder acted as a rational person of the same level of training would have under the same circumstances.

Consent

The responder must not commit assault by giving aid to a patient without consent.

Implied consent

Consent may be implied if the patient is unconscious, delusional or intoxicated — or if the responder had a reasonable belief that this was so; courts tend to be very forgiving in adjudicating this.

Consent may also be implied if the legal parent or guardian is not immediately reachable and the patient is not considered an adult (no matter what the patient claims).

Parental consent

If the victim is not an adult (warning: definitions vary), consent must come from the legal parent or guardian. However, if the legal parent or guardian is absent, unconscious, delusional or intoxicated, consent is implied (with the same caveat as above). Special circumstances may exist if child abuse is suspected.

Laws for first aiders only

In some jurisdictions, Good Samaritan laws only protect those that have had basic first aid training and are certified by the American Heart Association, American Red Cross, American Safety and Health Institute or other health organization. In other jurisdictions, any rescuer is protected from liability, granted the responder acted rationally.

NOW, does this mean you can’t be sued? NO, anyone can sue anyone. But unless you did something incredibly stupid, or charged for your services, or acted in bad faith, you are covered under the law.

MamaBear – at 20:53

I am from Michigan, too, but got sick of the winters and moved to AZ (83 degrees here today, just to rub it in, lol! But remember me when is 115 here and 80 in Traverse City!)

I have been looking into the issue of preparedness on a local level as well. The destruction of the health care system in New Orleans is a good model, but not exactly what we are dealing with here. Katrina totally blew away the physical infrastructure of New Orlean—and let us not forget Mississippi and Alabama. It is most likely (god willin and the creek don’t rise) that we won’t have the same level of physcal damage, including rising waters. The challenges are going to be in the areas the continuity of electricty generation, sanitation, and supply. Those components are obviously critical, especially in a state like Arizona, where we depend so much on outside resources. If those degenerate, (and they will—we went through a gas shortage in the summer of ‘03, and four hour waits for gas were common, as were fist fights, gun fights, and occasional random acts of kindness), things will get tough. If the supply fails (what I worry about) we will be measuring life spans in minutes and hours, not just days—both at home and in hospital. HCP are going to be at the sharp end of the rope no matter what happens.

I like the idea of prepositioning hotel rooms for rest and relaxation for first responders—we got plenty of resorts here. AZ has a fairly extensive cellular network for phone and broadband data coverage, so even in the event of failures, there are redundant networks in place for communication at all levels. We also have the largest nuke plant in North America, but a third of it is down for maintenance now. What does this tell me? We are all vulnerable.

Jefiner- I first worked as a Parmedic in Phoenix, back in 1975. Loved the April Weather. Shame it doesn’t last all year long. <g>

Anyone who wants to look up their state’s Good Samaritan laws should go here:

http://tinyurl.com/kgfqn

For my State, Florida, it reads:

Any person, including those licensed to practice medicine, who gratuitously and in good faith renders emergency care or treatment either in direct response to emergency situations related to and arising out of a public health emergency declared pursuant to s. 381.00315, a state of emergency which has been declared pursuant to s. 252.36 or at the scene of an emergency outside of a hospital, doctor’s office, or other place having proper medical equipment, without objection of the injured victim or victims thereof, shall not be held liable for any civil damages as a result of such care or treatment or as a result of any act or failure to act in providing or arranging further medical treatment where the person acts as an ordinary reasonably prudent person would have acted under the same or similar circumstances.

Hope this helps.

Funny….I have a SIL who currently lives in Manistee, MI and is moving to AZ in the next couple weeks. Talk about opposite extremes! That’s ok though, we get her snowblower lol! don’t think she’ll be needing it there.

From Fla_Medic – at 19:34

…Our focus should be on enabling those who can work, to do so with the most safety and effectiveness possible. …And an adopt an essential worker’s family program, so that people can work and know their families are being looked after.

SO, From all those willing volonteers, what could they do so the HCW’s fell support.

From Janetn – at 20:44

,,,We put up with more crap on a day to day basis then most of you laypeople imagine, but there is a limit, and forcing us to work without adaquate protection when there has been plenty of warning is unexceptable. Any of you laypeople who think otherwise go volenteer at one of the off sites during the pandemic - put your money where your mouth is.

SO, the Priority of the supportive volonteers is to get somme PPE via private means, NGO, local and regional, and from gifts from the wealthy. We now have a foundation that can emit Income deductible and where there is a Gov program that support Experiment Research Development, like we have here, that is for one dollars given to the foundation there is 1$ from the GOV.

Some quantities of PPE can still be bought. May the leaders of the Volonteer Support Group get those monies, emit the deductible receipts and buy as much as possible priority PPE identify by the HCW. It appears to us faster this way.

Fla_Medic – at 21:36 …We seriously need to consider if a policy of triage should be in place, where all flu victims are met in the parking lot, and sent home. Or perhaps to ad hoc flu treatment centers set up in gynasiums or community centers for those who have no families to care for them.

…Will our leaders have the political will to do such a thing? I hope so. As abhorent as it sounds, it’s better than the alternative. But that decision needs to be made now, before the hospitals are overrun, if it is to be effective.

SO, The collaboration od the Hospital Board was easier to get with the locals for the Triage concept to be implement, from bottom to top on this one as been more efficient and swift that from top to bottom.

From DebMcRN – at 22:15 ….Nurse hotlines for advise. Some sort of network where doctors can work with pharmacies to get prescriptions out to patients at home. Pharmacy deliveries by volunteers…..

SO, The hotlines allows to identify with precisions where outbreaks occurs, what are the contacts, what is the protocol, since the best way would be Om treatment to the max, then the gymnasium. The system is link to a data base to wich volonters and HCW’s have access and know the need of the Om patients.

Another concern is legal. If, as a nurse, I am caring for patients outside of a hospital environment, acting on my own and not under the guidance of a physician ,caring for neighbors and friends, would I be covered under the Good Samaritan Act?

SO, in a ‘force majeure’ situation it must be garantee by law.

Yep, Go get em girls. I guess that’s your choice. What a shame. I hope other medical professionals realize the magnitude of this event. “Hotel rooms?” You need help! Trained help. Why are you not starting there? This thread has now completely depressed me. We are screwed. Ricewiki said it better then I did. You must know that there are not enough RNs to handle a pandemic. When does the public get a chance to learn how to care for people, their families? After it starts? Do you think that is ethical in light of the very clear information we have now? We will be walking into a warzone with no preparation, no training. Why?????? What possible reason will you give after it’s over?

  http://www.interfax.cn/showfeature.asp?aid=11434

Have you read that? This is the most disturbing thread I have read. Why? It contains a possible solution to our greatest fear.

Forgive me. I mean no disrespect. I have a wife and a four year old son. I am terrified. My town has not even begun to prepare. I spoke with a friend today about Bf, he told me he had other things to worry about. That sums up the problem I face here. I am terrified.

Roman - I also mean no disrespect …but what do you expect trained help to be able to do for you?…sorry to depress you but there will be very little that we can do. We cannot be expected to walk into a warzone unprepared either.

from what i gather, unless you have a ventilator spare, there’s not much more can be done in a hospital than at home. Apart from being exposed to a virus pool of course. If (God forbid) i get this thing…the LAST place i’d go would be a hospital. May as well write your own toe-tag from what i hear. I think our best chance is educating ourselves with as much medical information as we can so we dont have to rely on health personel. Just my 2cents

So could we in lay-person wording make a ‘Bird Flu Infection Evolution’ and each step that we can take to cope with this, with meds and alternatives so that people in Om can at least be able to know what to do, when to do it and with what???

MamaBear, then it’s checkmate. Learning how to survive in a contaminated area would help. The classes would give weight to the situation. It would give the public a little more confidence if we have to step in and help out. Of course we will have to. Having a little training is simply humane. It should be done now. Not as an afterthought. I see this is not going to happen. What a complete and utter failure our medical system is (US). Whether we have a pandemic or not. The public now knows what a farce has been sold to us. There should be no doubt in anyone’s mind. A complete failure.

Snowy owl: I believe Dr Woodsons guide on this site has just that. I’ve printed it out and highlighted bits for my family in case they need to use it for me! I have some background caring for the sick so i know a bit more than them. But i think its well worth downloading it yourself.

It’s not just the information. It’s the involvement of the medical community. Handing my neighbor Woodson’s guide and saying there you go buddy, good luck, is not as effective as a local Doctor helping community members go through the guide and gain confidence with the material. It also sends a clear message how serious this situation is. That would help. It’s that simple.

We still have time to prepare even if it is buy some tuna or get our boss to get the right stuff to protect us in our job.We all had better do what we need to do.

Roman: Forgive me if i’m wrong but it sounds as though you think a Dr will be able to make a world of difference?? In my uneducated opinion, i think the best thing i’ve been able to do so far is accept the fact that I may die in this. Not that i will “go quietly into that good night” but it is a simple fact that some of us wont make it. I really feel for you in your anxiety…i just doubt there’s much we can do apart from what has been mentioned above. And i have every intention of surviving btw. Or else i wouldnt be here on Fluwiki ;)

Me too, I’m thinking of the folks who don’t understand the situation. We can still reach them. It will be much easier to get their attention and convince them that this is a health emergency if local Doctors/Nurses are ringing the bell, not a mechanic or accountant. That is a fact. Will we reach all of them? No. But a hell of a lot more then not trying at all. That makes our community safer and it just might help some people survive. Why is this concept so hard to understand?

I would very much like to see a teaching video up on the web here on donning and doffing PPE and basic nursing techniques for panflu. I keep suggesting this in hopes that someday, someone who can make films would take this on.

I’d dearly love to learn how to start an IV, but fully understand that it takes years of training to become a skilled phlebotamist. Or RT.

A good friend of ours is an oncologist and past administrator of our local hospital. When we went out to dinner and a concert together last October, I asked if the hospital had a panflu plan. No. Was not very well-informed about it. Asked me to write up a plan for him. I wrote up the plans linked to on the pandemic preparedness guides page; posted them on the web, got lots of feedback from city planners in London, Ojai, and Fairview, Texas. Gave the plans to our city and state disaster planners at a community disaster preparedness meeting in November, and was treated like some sort of nut.

I asked our physician friend how I could volunteer to help; after all, I am trained in biology and took care of my dying parents for 6 years. He discouraged me (possibly recognizing how foolhardy that might be). I asked to be trained in starting IVs, anything; he said that would not be useful. Redirected me to CERT, which has yet to incorporate pandemic training. I’ve made requests for this but have been ignored. I’ve contacted the Red Cross, who have also not responded. Our neighborhood CERT team all want to learn these things, but there is no one willing to train us.

I feel as though our nation is simply broken. When potential volunteers are ignored or turned away and concerned citizens are treated as though they are interfering with governmental delusions of competence, we have a serious problem.

If there is a nurse out there who can show these things — PPE, nursing — on video, please, even a home style video would be better than nothing. The sooner we are trained in nursing panflu, the longer the information has to seep into the community.

I realize we’ll be lucky to save a single soul in the natural course of the disease without meds or vents. Perhaps we can make someone more comfortable or can do some good somewhere. Perhaps it is just as our doctor friend has said — it will be triage and people dying in the home. And we’ll be digging graves in backyards.

BTW, I blame no one for any decision they make to save themselves in this potential disaster. I will rejoice for everyone not dead.

At least as long as I draw breath.

Roman, anyone who isn’t terrified simply isn’t paying attention. Sadly, that’s 95% of the public.

As far as training the public, I’m all for it.

In fact, I banged that drum some time ago in another thread. Suggested every community begin holding night classes NOW, on how to care for flu victims. 3 hours each night, open to the public, run one every night of the week. Make a video, and run it on local access cable. Train as many people as possible so they can care for victims at home. Emphasize isolation procedures and decontamination for the caregivers, so we don’t make matters worse.

Why isn’t it happening? Most people don’t want to hear it. That’s why. I approached some community leaders here in my town and offered to hold public education seminars on Avian Flu. Home nursing classes. I volunteered my own time, and was willing to pay to print the teaching materials from out of my own pocket.

The reaction? They listened politely and said, We’ll get back to you.’ So far, not a word. That was a month ago.

You think selling the idea of prepping to a friend, relative, or neighbor is tough? Try talking publicly about this issue. Believe me, all I’ve managed to do here is assure my reputation as an alarmist nutcase.

Eyeswideopen- I’ve had exactly the same reaction whenever I’ve tried to talk to officials about Avian Flu. I keep praying we get an early wakeup call, so that we can have some time to get things in place.

Starting IV’s isn’t rocket science. I could teach you in an hour. Sure, it takes practice to get really good at it, but most of the time even a novice can find a vein. Getting the IV solutions, infusion sets, etc. is the real challenge. I KNOW HOW TO START IV’s, and I can’t get them! So you think you’re frustrated? Welcome to my world.<g>

But despite all of the roadblocks, and the idiotic policies that seem to all but guarantee disaster, we still have to find ways to deal with this threat.

That’s why we’re here on the wiki. To bounce ideas off one another, to report on our sucesses and failures on the local level, and to hopefully find a combination that works.

I continue to hope for the video of basic PF51 in-home care techniques that will be playing 24×7 on monitors outside hospital areas, community centers, police and fire stations, et al. A stack of tapes could be placed near the monitor so folks could get the info and get back into quarantine.

I own a production company here in Asheville! I will start planning the video today. My friend owns a website and hosting company. I’ll try to have something up as soon as possible. I was contacted by a “Doc in Asheville” from the news thread. He is trying to set up a round table discussion. We may have something here. If you have any ideas for information that should go on the video, please send me an outline. I’m starting a new thread.

Roman – at 00:04

uuhhh Roman . . . apology accepted. The hotel rooms comment was in response on how to quarter HCP so they would not possibly infect their families, while working in hospital. I am not sure what you are looking for here—some great conspiracy by health care workers to keep you out of the loop of information? Why do you need doctors nurses et al. to do all the work on avian flu education? The last time I checked, Paul Revere was a silversmith with a mission.

That is why I like your idea about producing a video—*that’s* thinking globally and acting locally!

Jefiner, I made myself very clear. Now, give me your ideas about a video. That was missing in your last post. I find that ironic.

ROMAN, now THAT’s the sort of creative thinking we need here.

Never underestimate the power of the wiki. <g>

Fla medic, Give me your thoughts…. I’ll give you “Fla_Medic” a credit. I’ll make you a star!!!!

Go look in your thread, my friend. Already started. <g>

OK, it’s obvious that hospitals are not going to be there for the masses. I agree totally with Fla_Medic in regards to home care for the sick. Flu victims need to be instructed to remain at home. However, if they are expected to stay home, a network of phone advise, hotlines and a method of providing home care has to be available to them. There has to be some sort of criteria set to warrant home visits by HCWs.

Here is a sample senario, assuming physicians and hospitals are overwhelmed.

Prior to outbreak: Planning. Education. Volunteers (lay persons and HCW) organized and trained. Networks created (personal care, pharmacy/supply runners, meals on wheels, “tent city” workers, telephone trees to check on those living alone, etc). Everyone knows beforehand what their assignments are (what they are willing to do) and what central point they are to check in at when a pandemic is announced. Local command stations determined. Pamphlets and information packets distributed to every household in the community.

When TSHTF: Pt becomes sick with flu. He/she remains at home in quarentine and follows the advise that was already given in the pre-pandemic flyers and/or television and radio announcements. If the patient or family has questions/concerns/problems while at home that is not covered above, they should call the local hotlines. The first level at the hotline center are trained volunteers who can answer basic questions and direct them accordingly. The volunteers will have preestablished protocols set up by physicans or appropriate sources. The volunteers can refer the caller up a level to the nurse/paramedic when needed. They also will have protocols to follow and will be able to answer questions, send out an appropriate volunteer/HCW to the home for med/supplies, evaluation, personal care, medical care, etc.. If the nurse/paramedic determines the need, the caller can be then referred up to the physician level. Most likely, that leveled will be buffered and they will be available to cover prescriptions, advise other physicians, and answer questions that cannot be addressed by the 1st and 2nd tier.

This only the tip of the iceberg. I’m just a lowly ER nurse trying to eke out a living and I do not have a clue on organizing a community into action. So this leads to the most important point of all:

WHAT ORGANIZATION(S) IS RESPONSIBLE FOR GETTING THIS BALL ROLLING? WHY ARE PREPARATIONS NOT BEING DONE NOW?

This is terrible, but true. I’ve tried to talk to people about the avian flu and them to prepare and 98% of the time I get the look/response that I must be mentally impaired. I don’t want a reputation of being a nut so I quit talking about it. My preps are ready. So why the heck am I put in that position? It’s hard for individuals like myself to get things rolling. We get written off. People need to hear it from the BIG organizations. In addition to FEMA,WHO, CDC, how about the AMA, AHA, ANA, etc. It seems like there are mentions and lame warnings, but NO ACTION. These organizations need to act now.

What exactly can you put on this video? I AM a nurse and even I don’t know what in the hell I’m going to do if my own kids get sick. Yes, I know how to start IV’s but do I have the equipment needed??? No. The point is there is NOT much you can do. Control the fever, try to prevent dehydration, and pray for the best. The only thing the video may establish is preventing infection. Good luck and I commend you for at least trying to do something. I feel your frustration and terror…I’m right there with you.

MamaBear, Some people are visual learners. Most people retain things better viewing both written word and images. Fla_Medic has given me a start. Give me any thing you got. Yes, I am contacting a lawyer. A disclaimer will be very visable.

Mamabear- We’ve started hashing it out in the Flu Video thread. Would love to have your input, along with the other’s in this thread.

Granted, this is nusing 101, but that’s what’s gonna be needed.

The goal here is to make it possible for people to provide basic care in the home. No heroics. IV’s aren’t gonna happen. Vents aren’t gonna happen. We’re back to 1918 level of care. BUT, if it’s done in the home, with phone support like DebMcRN described, it could save the hospitals and the HCW’s from complete collapse.

DebMcRn, I like your ideas. We now need to figure out how to implement them.

err, make that NURSING 101 <g>

Roman, the doc in asheville is a she not a he! To my knowledge it will be the first big prep discussion around here. Local TV station will surely be available and probably local gov’t. I have been put in charge of arranging the whole deal and will post when info available.

Roman: Thank you so much for answering my plea. I hope you and Fla_Medic make one hell of a teaching video!! If there’s anything I can do to help, please let me know.

Fla_Medic at 2215: re: “Maybe the next pandemic, we’ll be better prepared.”

I suspect that was said in 1918……………

Roman/doc in asheville etc..the video is a really good idea…if there is a local school of nursing nearby, perhaps you could collaborate with one of the educators there….

Well I feel better,..

Some may have the report from Paris ( http://tinyurl.com/hmg49 ) indicating the difficulty in transmission of H5N1 from H2H. If in fact the infection is occurring at the alveolar level and not in the conducting airways, this would be a big relief from my POV. Organisms infecting the larger airways frequently attach to water particles present in the airway and are expelled in the high velocity of coughing and normal breathing, where air flows are high. There is normally only water vapor in the alveoli and the airflow is very laminar and slow. Typically, if you want to recover organisms from the alveoli, you do a BAL, or broncho-alveolar lavage, by squirting in a large amount of saline and suck it back out. If the pandemic strain causes the same kind of cytokine-ARDS we’ve seen with the avian strain and spares the upper airway, viral shedding will be attenuated by this difference.

We have our own axiom from “it’s not the volts, it’s the amps that get you” wisdom. It is not the known infected patient you fear, but the one you don’t know is infected. Patients with known infections on or off ventilators in the future doesn’t worry me as much as the ones being triaged or tested in the waiting areas. I hope we have a lot of N-95s and gloves, but the bigger chance of getting infected may come from fomites and fingers. Wash, Wash, Wash!!

Well I feel better,..

Some may have the report from Paris ( http://tinyurl.com/hmg49 ) indicating the difficulty in transmission of H5N1 from H2H. If in fact the infection is occurring at the alveolar level and not in the conducting airways, this would be a big relief from my POV. Organisms infecting the larger airways frequently attach to water particles present in the airway and are expelled in the high velocity of coughing and normal breathing, where air flows are high. There is normally only water vapor in the alveoli and the airflow is very laminar and slow. Typically, if you want to recover organisms from the alveoli, you do a BAL, or broncho-alveolar lavage, by squirting in a large amount of saline and suck it back out. If the pandemic strain causes the same kind of cytokine-ARDS we’ve seen with the avian strain and spares the upper airway, viral shedding will be attenuated by this difference.

We have our own axiom from “it’s not the volts, it’s the amps that get you” wisdom. It is not the known infected patient you fear, but the one you don’t know is infected. Patients with known infections on or off ventilators in the future doesn’t worry me as much as the ones being triaged or tested in the waiting areas. I hope we have a lot of N-95s and gloves, but the bigger chance of getting infected may come from fomites and fingers. Wash, Wash, Wash!!

rrteacher-that report is sort of good news, bad news…good news, it’s lower not upper airway…bad news- avian flu viruses are not supposed to be able to to insert anywhere on human airways tree!!

guess it’s a case of 1/2 full vs 1/2 empty

And it does not speak to what mutations/reassortments/recombinations may come. So I think we’re still where we were before this was conclusively demonstrated but suspected. No change in threat.

rrteacher:

eyeswideopen – at 17:29 has the key theme. The point of the two studies (Nature and Science) is the description of why it’s tough to catch now (and perhaps why it gives such a whopping pneumonia). It says nothing about next, week, next month, next year if the virus changes.

And for those who say it hasn’t gone pandemic yet, remember it sat in SE Asia for more than 10 yeras before exploding all over the world this year. That doesn’t say more will come, it says we don’t know everything about this virus.

Getting back to Canada, the fines are not law, it has been tabled, it has gotten resistance, it is unclear what happens next.

DemFromCT: Thank goodness they thought better of it than to push it through. I recall a medical draft proposed by Bush a year or two ago — I wonder if that is our version of same? It would be classic but if the politicians gave themselves the tiny amount of vaccines and Tamiflu but expected HCWs to fight and die in a pandemic. As it is, I believe HCWs are number 4 or 5 on the list of who gets vaccine and antivirals. It makes me angry. And I don’t understand why we’re not in a fever of building vaccine capacity here in the US not to mention PPE and vent factories.

Very true. We really do not have any idea on what will happen. The government, like the virus may or may not change. I do like this trend where more people are willing to do something to change the conditions. Nothing the HC industry has done so far surprises me. Several people being told that their community hospital hasn’t got a plan have been ask to help make one. More and more opportunities to prepare those just waking are presenting themselves. I bet there are HC administrators lurking here and there today trying to find answers to the questions we ask them yesterday. I like less of “I will, I won’t, I don’t know” and more “I will, but this is what needs to be done if I’m going to”. I am writing my professional organization a letter along the lines of, “if you want RTs there when TSHTF, you need to consider what it will take to get them there”.

link

A smart fellow I know sent this in. The qustion is how do you operationalize this? This means prep!

rrteacher: Yep, I was asked to draw up a plan for a friend, an oncologist and past hospital administrator for our local hospital, whole story up at 3:22. Did it for him in October. The kicker is this: he didn’t even read it until last month. And this is a brilliant, compassionate, deeply concerned physician, really among the best humanity has to offer. Everyone is so busy with the overload of suffering that walks or rolls in their doors every day. They’ll need our help, but they don’t even have he time to train us so we can help them in the best way.

Our healthcare system is broken.

I love the idea of training to become an EMT, however. That works for me.

I would to partner with EMTs to provide respiratory/ventilator care. Theirs will be the First hand I look for. Nobody, including RTs, is better at keeping people alive under bad conditions with inadequate equipment. There will need to be a seamless approach to respiratory care WTSHTF, and EMTs will have begun that process before I see the patient. Silicone is easy, Carbon is hard.

eyswide,

I already signed up. This will be an interesting spring.

Melanie: How did you locate your local EMT group?

Fla_Medic nailed it: call them on their non-emergency number at your firestation and contact your local community college for their training program.

Melanie: FOUND IT! Thanks.

May make my quota this month, after all! <g>

Proud beyond words of both of you. :)

On the video KISS start with how to don and remove PPEs handwashing 101 a little on universal precautions, how to change sheets with a pt in the bed. Keep it to comfort, treatment isnt really an option anyway.Thats my two cents

Fla medic my solution - scream, yell, throw fits, with the media, government, anyone with the authority to get supplies. An executive order by a governor requiring hospitals & local governments to buy x amt of PPEs and other supplies should be demanded, by the public [us ] now. We do have the power of the vote last I looked. Resigning to the fact that nobody will do anything isnt an answer.

Roman – at 07:45 “Jefiner, I made myself very clear. Now, give me your ideas about a video. That was missing in your last post. I find that ironic. “

• geez* Roman, no need to go and get all snotty. I actually had to go to work this morning—take care of my patiens—gotta pay for all the preps, yanno. I couldn’t spend any more time on the wiki! I will definitely go over to the other thread and post as well.

My thinking? Break it down into relatively simple components. 1. The flu, what it is, how it is spread, what the results are, probablilities of fatalities. 2. Preparations—keeping it simple again, maybe post up what one person will need (food, water and meds) per day of quarantine and project out over expected quarantine periods. 3. Infection control. I saw (posted on another thread) an excellent website from the Australian government on infection control, everything from washing hands, to don/doff of PPE. 4. Caring for the sick—symptom management, how to set up a sickroom, managing dehydration and nutrition, and one short piece on what to do if someone dies. 5. Safety and security. Enough said. 6. Anything else I have missed, toss it in . . . this is a work in progress.

I need to step away to make dinner, but promise to be back in an hour.

I think keeping the focus on nursing the patient would be terrific. Since the Australian video covers PPE reasonably well (although I could see another, more detailed take on the subject — for example, there was no treatment of hair covering, facial hair, makeshift fit testing or shoe sterilization, nor what one does to sterilize goggles after removal), I would like to see a thorough treatment of nursing care under both best and worst case scenarios with respect to what preps (meds, PPE, fluids, gear, etc.) are available.

Jen My advice is to keep it very simple - #4 I dont know that there is symtom management in a home setting without a whole lot of equipment and training. Id focus on comfort measures this will give the caregivers a sense of doing something and provide the sick with compassionate care and comfort as far as that will be possible, Frankly your either going to survice or not, There is no homecare treatment that is going to change the outcome.

Do you have access to any hospice videos? Hospice has pretty much devoloped compassionate homecare.

Thank you, Jefiner. That is great information. Please keep it coming. I have several people lined up to track and collect these comments. We will keep it simple. Compassionate care and safety is the focus. Post additional info on the flu video thread. Thanks again.

Thanks to everyone!!!!!!

Thanks to you Roman. We all owe you our gratitude.

Is there a model hospital that is openly engaged & working with their staff (including support staff such as environmental services, nutritional support etc) to predict, build upon & maximize human resource response?

GhostRN-Reopening this thread was probably a good idea. The last burst of posts occurred about 6 weeks ago. I can’t say a lot has changed. Harborview Medical Center in Seattle, King Co, Washington still has the early out plan. It is the only hospital plan posted on the Wikie. Not much has changed. But other than Flufighting rhetoric, I can’t say that much else has changed either. We continue to have sporadic deaths in Indonesia and the Middle East, and rumblings in China, but other than that, the virus hasn’t made a big move, Bush League and TV Movies not withstanding. There are certainly a lot of committees and summits with everyone nodding and harrumphing, but don’t expect a major push til the virus makes a big move. We’re all “what iffed” out. I would expect a traveler with confirmed H5N1 or a migratory bird, either one, entering the US would be the next Big push.

I have a problem with stating health care workers have a protected postition in society and benefited economically from it. Yes a have benefited economically from my job, as has everyone elso who is employed. No one paid for my education, I worked full time while I went to nursing school.

If a pandemic happens in the USA, most hospitals are not stock piling PPE to protect health care workers. Even if they do will it be enough to protect us. I have a family to protect, and they come first. Who will protect them while I am working. If I go to work I will have to isolate myself from them for the duration of the pandemic. I feel that a very high percent of health care workers will die if a pandemic happens.

I have asked Physicians on commitees and they have stated that our community is doing nothing to prepare for a pandemic. We are on our on, so each of us need to prepare ourselves to take care of our on as well as we can.

Seems like there would be a benefit to knowing what the pandemic intentions of your staff are, including support service staff. However, the degree of dedication to the facility may be higher if the staff knew of hospital pandemic plans and felt the hospital was capable of pulling them off because of preparedness/educational activities that were known. To survey without pre-empting with preparedness info to staff (how we’re going to meet reasonable needs and minmize risks) might result in reduced response levels later. Seems like a businesses of all types, and especially those like dr’s offices/hospitals would want to get a sense about their human resources for planning/response purposes. For instance, responses to this question alone might provide much needed insight- 1) Imagine a situation where you are needed to reside at the hospital to provide critical services during a crisis such as a pandemic for 2 weeks or more. What are your thoughts?

Deb McRN wrote I’m just a lowly ER nurse trying to eke out a living and I do not have a clue on organizing a community into action.

Honestly, try googleing for “open space Harrison Owen user guide”. You have the power to invite those who care. If only two or three people come, then you start with that. Remember to keep the space open (if you use open space, that is): don’t say “we should do this” but “what *can* the three or four of us do?”. Maybe the only thing you can do is write letters, or convene another meeting next week, or ask for advice here, or whatever.

The power to invite. That’s how this wiki was started, right?

“I’m just a lowly ER nurse trying to eke out a living and I do not have a clue on organizing a community into action.”

Deb- same boat as me…get educated on the issues- doesn’t have to be 100%, and be a PIA! be persistant- approach your mayor, committee people, wardperson, any one and do it alot! speak in public sessisons at township meetings. I have-so far-the township BOH and committee on board.

The person most convinced right away in my township is a middle-aged woman who is in charge of the BOH locally. She knows the fed gov’t can’t be depended on to come to our aid. Mail letters- show them the last paragraph on page 9 of the new “Implementation Plan”. Speak to the county health dept and don’t take “no” for an answer. Contact papers, etc etc. Do what it takes-it’s not just for you. Be pushy, bossy, nosy, a burr in the saddle.

Deb McRN: http://www.fluwikie.com/pmwiki.php?n=Consequences.SelfOrganising

From somewhere else on this site: - low-tech: http://www.openspaceworld.org Open Space Technology “discovered by” Harrison Owen and with a practitioners’ list (google for OSLIST and you’re there) provides a low-tech aproach to such cooperation. If people are afraid to meet in large numbers then it’s best to use OST in advance, not when the pandemic is among the people.

• http://www.openspaceworld.com/users_guide.htm
• http://listserv.boisestate.edu/archives/oslist.html

It looks like we could start a thread about helping Deb McRN, right? Grace RN? There was this “distributed leadership” idea …

• Start with http://www.michaelherman.com/cgi/wiki.cgi?OpenSpaceTechnology/GuidedTour
• And http://www.michaelherman.com/cgi/wiki.cgi?OpenSpaceTechnology/InPictures
• http://www.michaelherman.com/cgi/wiki.cgi?OpenSpaceTechnology
• http://www.michaelherman.com/cgi/wiki.cgi?OpenSpaceTechnology/ExecutiveSummary
• http://www.michaelherman.com/cgi/wiki.cgi?OpenSpaceTechnology/EssentialElements

Source: globeandmail.com: Ontario health workers to get pandemic kits

The Ontario government says it’s one step closer to being ready for a flu pandemic.

Health Minister George Smitherman announced today that 15,000 emergency kits will soon be sent to front-line health-care workers across the province.

The kits contain masks, gloves, disposable gowns, eye protectors, hand sanitizer and a surface cleaner.

Mr. Smitherman says Ontario’s pandemic plan is constantly improving, but he’s critical of the federal government’s preparations.

There is currently enough of the antiviral drug Tamiflu stockpiled for about 17 per cent of Canadians.

But Mr. Smitherman says we should be up to the World Health Organization’s benchmark of 25 per cent.

http://tinyurl.com/n457j

“The emergency infection control kits are being sent out to community-based physicians, Family Health Teams, Community Health Centres and midwives. Each kit contains:

200 non-latex gloves, 20 disposable gowns, 500 ear-loop procedure masks, six pairs of reusable eye protectors, six bottles of hand sanitizer, and a surface cleaner Information/instruction on personal protection equipment Infection control guidelines

“The government has learned from the SARS outbreak what a challenge it can be to get supplies out to key health care providers who don’t work in hospitals or long-term care homes,” said Dr. Sheela Basrur, Ontario’s Chief Medical Officer of Health. “Arming these providers with pre-placed emergency kits is a wise move that can help save lives during a major health emergency.”

The government worked with the Ontario Medical Association, the Ontario College of Family Physicians and the Provincial Infectious Diseases Advisory Committee in developing these infection control kits.”

Notice that the kits are sent to doctors. Ontario Nurses Association are conspiscuously absent from the discussions. ONA has objected to the use of regular surgical masks and has asked for N95. Is ONA is being shut out of the discussions? Nurses are going to be ‘told’ by doctors it is safe to use surgical masks to care for the sick.

May be after the first few weeks, half the nurses will develop immunity and so no more masks or antivirals needed for nurses.

The other half is canon fodder.

The PR is good though.

Dr. Basrur knows nurses who didn’t kept their N95 on during SARS got sick. Money and power talks.

Old thread - Closed to increase Forum speed.