Will you work during a Pandemic?

[Goju]

admin note: we just added a poll to this thread today, april 25, 2008, please take a second and vote in the poll so we can have a graphical representation of the responses. thanks

scenario:

h5n1 (the bird flu) mutates to become efficient at transmitting human to human causing a pandemic, with a case fatality rate of 60% and with 80% of the cases in the 0-40 year old age range.

see:

http://www.wpro.who.int/nr/rdonlyres/fd4ac2fd-b7c8-4a13-a32c-6cf328a0c036/0/s4_1113.jpg

hospitals will be quickly overrun. hospital staff shortages are 50%. the government orders all nurses to work. there is not enough personal protection equipment (n95 masks, gloves, goggles, tamiflu, vax, etc)

home quarantines become common (in the fed plans).

your family is also quarantined in your home. you are running out of food and the government promises you will be "taken care of" if you report to work.

will you go?

[canoehead, BSN, RN]

Not to be crass, but what the heck...

A mass thinning of the gene pool will do us some good. The world is over-populated, and the ratio of bodies to IQ points is probably less than 80. Keep in mind that those hit hardest by the flu virus will be the ones that wash their hands (and other body parts) the least. I, for one, am looking forward to the pandemic, and have boycotted the flu vaccine in hopes of assisting in the spread of the virus.

[Goju]

Dont know how long this site will stay up but a very interesting dialog between the people and the HHS/CDC/DHS on Pandemic Vaccine Priority

http://www.webdialogues.net/cs/panflu-engage-home/view/di/104?x-t=home

[azhiker96, BSN, RN]

Goju, thanks for posting that link. It looks like the gov't is taking inputs, or at least has a discussion board where people can post their ideas.

Canoehead, I was just thinking about population studies. Whenever a population grows too large and gets overcrowded; famine, war, and disease thin the herd. It's not be kind, gentle, or PC. It's just nature. There will be some who refuse the vaccine because it's not been sufficiently tested or has mercury in it or because it's not guaranteed to prevent illness. That's fine also. The vaccine will be in short supply anyway so there's no need to force it on folks who don't want it for whatever reason. Sometimes you have to let natural selection kick in.

[Goju]

FYI - Not H5N1 bt see how the HCW respond when not enough PPE is available?

Uganda: Union Urges Medics to Quit Ebola-Hit Area

The Nation (Nairobi)

7 December 2007

Kampala

"The Uganda Medical Workers Union, an umbrella association of about 20,000 health workers in the country, has asked scores of under-resourced and unprotected medics attending to Ebola patients in the worst hit Uganda's western district of Bundibugyo to leave immediately.

"All (health) workers who are not provided with protective gear should not work on suspected Ebola cases and (should) leave straight away," the Union chairman Dr Apollo Nyangasi said on Thursday. The recall comes a day after Dr Jonah Kule, a medical officer at Bundibugyo Hospital, his junior Joshua Kule, a senior clinical officer, Ms Rose Bulimpikya, a matron at the same hospital and another unnamed nurse, who all contracted the haemorrhagic fever from patients they were treating, died.

They bring to 18 the cumulative number of medics lost to Ebola since its outbreak in Gulu in 2000 in which at least 14 nurses died on duty alongside Dr Mathew Lukwiya, the then Medical Superintendent of Lacor hospital, who has since been declared a national hero.

"Losing one health worker," Dr Nyangasi said, "means endangering the lives of over 15, 000 people since the ratio of health workers to the population is 1: 15, 000 and we call upon government to be proactive in cases of epidemics but not reactionary like now". - excerpt

http://tinyurl.com/yr4n6o

[indigo girl]

I have been watching and reading about this group, Trust for America's

Health. They have been very busy across the country educating, and

meeting with different communities and groups of stakeholders

to help them to prepare. One of their latest endeavors was this drill in Chicago

that was organized to look at how such an emergency could affect all essential services.

http://afludiary.blogspot.com/2007/12/chicago-officials-train-on-crisis.html

I was looking at their website this morning, and was surprised to see that the following groups

are part of the Working Group Members. There is a nursing

organization listed. So there are professional organizations out there already

that take this threat seriously, and they are providing training. This is what is

needed, and what they are doing is impressive.

Working Group Member List

American College of Nurse-Midwives

American Lung Association

American Osteopathic Association

American Medical Women's Association

American Society of Health-System Pharmacists (ASHP)

American Public Health Association (APHA)

Association for Professionals in Infection Control and Epidemiology

Asthma and Allergy Foundation of America

Campaign for Public Health

Center for Biosecurity, University of Pittsburgh Medical Center

Center for Infectious Disease Research and Policy

Federation of American Scientists

Foundation for Allergy & Immunology Research

Infectious Diseases Society of America

RetireSafe

Service Employees International Union

Trust for America's Health

http://www.pandemicfluandyou.org/

[Laidback Al]

Nurses left short in emergencies: Study

By KEVIN CONNOR

Nurses face significant gaps when it comes to support during health emergencies such as a flu pandemic, says a new study.

"The weaknesses and gaps in human resource support identified in our research jeopardize the capacity of Canada's health-care system to prepare, respond and recover from infectious disease outbreaks and other crises," says lead researcher Dr. Carol Amaratunga of the University of Ottawa, whose Women's Health Research Unit carried out the study.

"Strengthening resources and support would also enhance public health and safety."

The study, Caring for Nurses in Public Health Emergencies, calls for greater support for emergency preparedness and response, as well as workplace improvements to better protect nurses in crises. . . . .

http://www.torontosun.com/News/Canada/2008/02/28/pf-4881590.html

credits to FLA_MEDIC

[Laidback Al]

The results of this study severely contrast with posts from HCWs in this thread and other Pandemic Flu forums. see: http://www.flutrackers.com/forum/showthread.php?t=39457

These results may be skewed by the local cultural values of HCWs in Singapore who responded to the questionnaire.

Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic - a Comparative Study between Healthcare Workers in Primary and Tertiary Care.

Wong TY, Koh GCh, Cheong SK, Lee HY, Fong YT, Sundram M, Koh K, Chia SE, Koh D.

Department of Community, Occupational and Family Medicine, National University of Singapore, Singapore.

Introduction:

With the potential threat of an avian influenza (AI) pandemic, healthcare workers (HCWs) are expected to play important roles, and they encounter significant stress levels from an expected increase in workload. We compared the concerns, perceived impact and preparedness for an AI pandemic between HCWs working in public primary care clinics and a tertiary healthcare setting.

Materials and Methods:

An anonymous, self-administered questionnaire was given to 2459 HCWs working at 18 public polyclinics (PCs) and a tertiary hospital (TH) in Singapore from March to June 2006. The questionnaire assessed work-related and non-work-related concerns, perceived impact on personal life and work as well as workplace preparedness.

Results:

We obtained responses from 986 PC and 873 TH HCWs (response rate: 74.6% and 76.7%). The majority in both groups were concerned about the high AI risk from their occupation (82.7%) and falling ill with AI (75.9%). 71.9% accepted the risk but 25.5% felt that they should not be looking after AI patients with 15.0% consider resigning. HCWs also felt that people would avoid them (63.5%) and their families (54.1%) during a pandemic. The majority expected an increased workload and to feel more stressed at work. For preparedness, 74.2% felt personally prepared and 83.7% felt that their workplaces were prepared for an outbreak. TH HCWs were more likely to be involved in infection-control activities but the perception of infection-control preparedness in both groups was high (>80.0%).

Conclusions:

HCWs in both public primary and tertiary healthcare settings felt prepared, personally and in their workplaces, for a pandemic. Their main concerns were risks of falling ill from exposure and the possibility of social ostracism of themselves and their families. Preparedness levels appeared high in the majority of HCWs. However, concerns of HCWs could affect their overall effectiveness in a pandemic and should be addressed by incorporating strategies to manage them in pandemic planning.

http://www.ncbi.nlm.nih.gov/pubmed/18327343?ordinalpos=37&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

credits to Sally

[indigo girl]

.

For preparedness, 74.2% felt personally prepared and 83.7% felt that their workplaces were prepared for an outbreak. TH HCWs were more likely to be involved in infection-control activities but the perception of infection-control preparedness in both groups was high (>80.0%).

HCWs in both public primary and tertiary healthcare settings felt prepared, personally and in their workplaces, for a pandemic Preparedness levels appeared high in the majority of HCWs

Are they talking about mental/emotional preparedness? It sounds like it.

My thoughts about this are that in order to have confidence in the workplace,

and feel safe there, nurses need to know that the facility has stocked adequate

PPE, and can provide security for physical safety. That security might be

armed guards, having adequate food, and a place to sleep in case you can not

leave the facility. You would want to know that the facility has a detailed disaster

plan in writing that they have practiced, demonstrating some foreknowledge of

what type of risks are involved to their facility and staff in this specific type of

event because it will not be just risk of disease.

This study about the HCW in Singapore did not define preparedness. I would like

to know what those nurses were thinking. Maybe it is part of their culture to have

faith in their employers ability to provide for their safety.

And, then there is the matter of personal preparedness, and what does it mean?

So, I would have to say that this study gives me the impression that it is about

their mindset, and not about whether or not they really have the supplies

necessary in their homes or workplaces that would help keep them safe.

Maybe, I am talking about safety preparedness and they mean some other type

of preparedness entirely. We are not going to know because it is not addressed

here. Too bad really,because it might be worth knowing if they had some

workable solutions that no one else has thought of.

[MTRN13]

"personally, that seems like a very good time to sail the boat off into the sunset. no ppe, no work!"

this is the best suggestion i've seen here. i would have to stay with my family. for the nurses who are willing to work, i admire you. . i wish i could say the same. i would want to be with my family. i couldn't leave my son, husband,or parents. it's a very scary thought this could happen. if i were already exposed i would stay away for a while, till i knew i didn't have the flu. then i would return to my family. this thread definately has me thinking. what would this world turn into ? i'm sure there would be riots and society as we know it would shut down. i personally hope this is just an awful thought we have and it never comes to be.

[gr8hart]

My question may have been covered already, but I need to ask it.

Does anyone know what the legal ramifications of not showing up for work are? Does it depend what state you work in?

Any links would be greatly appreciated.

[indigo girl]

My question may have been covered already, but I need to ask it.

Does anyone know what the legal ramifications of not showing up for work are? Does it depend what state you work in?

Any links would be greatly appreciated.

I have not seen any legal ramifications written anywhere, not even in individual

states pandemic plans.

However, individual facilities do have some written warnings...

My new job has a disaster plan. Team A relieves Team B. No shows will be terminated.

Of course, not going could save your life when they run out of PPE.

You can always get another job.

They will still need nurses when it is all over.

[indigo girl]

Potential Penalties for Health Care Professionals Who Refuse to Work During a Pandemic

http://www.flutrackers.com/forum/showpost.php?p=143904&postcount=73

4gr8greens, you probably already saw this link at flutrackers? I just found it today.

We should probably look into this further, and see if other states have similiar

emergency health powers acts, and exactly what they expect of HCW.

Some states, such as Maryland and South Carolina, have enacted laws that subject HCPs who refuse to work during a pandemic to penalties in a far broader range of circumstances than those described above. Many of these laws are based on the Model State Emergency Health Powers Act (MSEHPA), which authorizes public health officials to order HCPs "to assist in the performance of vaccination, treatment, examination or testing of any individual as a condition of licensure, authorization, or the ability to continue to function as a health care provider in this State." Some states, including Maryland, have gone further than the MSEHPA by authorizing fines or imprisonment of HCPs who disobey orders to work.