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?

[betsey811]

The state of Indiana has a registry for people in the health care field to join (volunteer) in the event of such an emergency. "The government will take care of you"??? It depends on who's running the show....the same idiots who ran Katrina...or Obama's posse? I certainly hope we are prepared for what may come.

[Ayrman]

Interesting if telling tidbit from my current employer. We currently have a patient under isolation who will be with us for a while, and has been for a couple of weeks already. Active TB case, no other co-morbidities. The percentage of nurses who basically refuse to accept assignment for this patient - they (the patient) are otherwise a cakewalk - is currently running well in excess of 50%.

This is something we all see eventually - TB that is. The patient rarely coughs, is in a reverse air flow room and other than meds, routine vitals and hotel care (food, etc) is quite content to watch TV and veg. Pleasant, cooperative and goes entire shifts without requesting so much as a sandwich or a soda.

What do you think the chances are that these same nurses will put themselves at risk during a true pandemic when the number of cases runs into a high percentage of total patient load on the floor? 1 or two reverse airflow rooms, and maybe 10, 15 or 20 active flu cases on the floor, possibly infected with a flu variant with a relatively high case fatality rate?

Ayrman

[Laidback Al]

. . . What do you think the chances are that these same nurses will put themselves at risk during a true pandemic when the number of cases runs into a high percentage of total patient load on the floor? 1 or two reverse airflow rooms, and maybe 10, 15 or 20 active flu cases on the floor, possibly infected with a flu variant with a relatively high case fatality rate?

Ayrman

I imagine that a change in the CFR (for the worse) will be THE deciding factor for most HCWs on whether or not they will continue to show up for work.

[ladnewnurse]

I would love to say that I would be the hero & go, but I wouldn't be honest if I said that. I'm young, alot ahead of me & I don't want to risk it. I won't lie!!!! I will want to take care of me & my own before I take care of everyone else's!!! May sound harsh, but you have to take care of those you love!

[indigo girl]

N95's are still recommended!! The IOM has decided this based on the best available evidence, and put out their report today.

Lots more research needed on this, all agree.

http://docs.google.com/gview?a=v&pid=gmail&attid=0.1&thid=12380b820ee09091&mt=application%2Fpdf

Think about it. If your patient with swine flu is coughing, do you want to be wearing only a surgical mask for protection?

I don't.

I am going to be thinking about those 40% of patients that died who had no prior existing condition. I am going to be remembering that unlike seasonal flu, swine flu has the ability to deeply penetrate the lung. And, I am going to be remembering that

this flu is way more transmissible than seasonal flu if for no other reason than

that no one has any immunity to it yet.

I would rather be inconvenienced than sick or possibly dead and my family left with a mountain of debt because these patients that end up on vents stay there a very, very long time, and face a very long rehab if they survive.

IOM committee did say, and I agree that much more research needs to be done on how influenza is transmitted, and on PPE.

Sometimes the face mask might be OK. If your patient is a not cougher, and you are not doing neb tx, I could see it, but otherwise, I want the N95 protection.

Here is another reason why you should be wearing more rather than less protection:

http://afludiary.blogspot.com/2009/09/pathology-of-fatal-h1n1-lung-infections.html

[indigo girl]

http://www.bloomberg.com/apps/news?pid=20601202&sid=aGpN0bZcUDbg

Dr. Raina McIntyre again presents her information on the surgical mask vs the N95, and it is very clear that the N95 is more protective. The IOM agrees.

Surgical masks didn’t stop the spread of flu and other respiratory illnesses during a five-week study involving 1,936 health-care workers at 24 hospitals in Beijing last winter. Thicker versions designed to better fit the face, called N95 masks and made by 3M Co., reduced flu by 75 percent. The N95s cost 5 to 10 times more, said study author Raina MacIntyre, head of public health at the University of New South Wales in Sydney.

Surgical masks have been an icon of medicine, popularized on TV from the 1970s series, “M*A*S*H,” to today’s “Grey’s Anatomy.” They were widely used in outbreaks of H5N1 bird flu and SARS. In July, 3M said it would invest $20 million to boost supply of N95 masks by 10 percent. MacIntyre, the lead author, said surgical masks should be scrapped and replaced by N95s.

“This is a landmark study that will change most public health approaches,” said Lindsay Grayson, a professor of medicine at the University of Melbourne. “If you’re going to be truly protected, you’ll need an N95 mask. A number of governmental recommendations will need to be changed.”

MacIntyre presented her findings at an infectious diseases conference in San Francisco.

http://www.icaac.org/

(hat tip FlaMedic)

[Woodenpug, BSN]

SCBA's provide even more protection than m95's.:wink2:

Just a gentle reminder:

"# Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

# Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

# Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.

# Avoid touching your eyes, nose or mouth. Germs spread that way." from http://answers.flu.gov/questions/3869

Also, you need eye protection or a face shield when close enough to catch a lugie.

[WV_RN]

Running out of food is NOT a concern for me. I just rec'd another year's worth today, as a matter of fact. My UPS driver didn't even seem too annoyed to be hauling in an 800 lb shipment. I've taken care to prepare myself sufficiently for just about any eventuality (from Alien invasion to Zombie apocalypse, lol) and have encouraged others to do the same.

I do not need the government for anything--except to stay out of my way and let me live my life. I will never do anything merely because they order me to or promise to do something for me in exchange--governments darn near always lie.

Depending upon the situation (e.g. roads open, limited risk of random violence), I might continue to work my scheduled (home care) shifts. I would NOT go work in a facility in which I have no experience, no confidence, nor orientation to basically die r/t lack of PPE. If the mortality rate were lower and there were adequate PPE I'd be much more inclined to VOLUNTEER to help people.

I chose nursing as a career in order to provide care to people, but I have to protect myself first. Going in without adequate PPE and becoming a casualty myself would not accomplish anything. In the above scenario, I most likely would fall back to my retreat and be prepared to live there for a year or two until the pandemic burns itself out. At the very least, I would isolate myself inside my home, not leaving unless absolutely necessary.

Good post. Storing the essentials, food/water, weapons and ammunition are a priority for my family as well.

[Aaron86]

Hell yes if it means I could actually find a job!

[IlovenursingRN]

I will definately be working during a Pandemic!

[Woodenpug, BSN]

ROFL, LAMO.... Yes, alarm-ism causes harm. How many deaths, because you needed to cause a non-crises?

[Maria Lenore,RN]

wow.... no.....