Are you prepared for Avian Flu?

SmilingBluEyes · Nov 25, 2006

Really lengthy and thought-provoking thread exists here:

https://allnurses.com/forums/f195/pandemic-flu-thread-ii-184877.html

Enjoy!

LMonty911 · Dec 2, 2006

I just finished reading the Pandemic thread II. Well done, Indigo Girl!

I dont think that my hospital is prepared at all. I find that scary, both for myeslf and my coworkers and the community we are pledged to serve. unless we prepare I dont see how we can keep the doors open.

Why? In the ED I work in, very very few nurses (like ONE!) have stated they will work in a pandemic thats as bad or worse than 1918. I personally have reservations about staying past the point that the PPE is gone if were looking at a high CFR (Case Fatality Rate).

Right now, the CFR is about 60%.

I'm dedicated, but not stupid!

So I'm planning on personal preps to see us through a bad one, and that's concerning to me.

Do you think nurses will stay on the job if the CFR is high, and theres no antivirals (After all, the national stockpile of tamiflu, relenza and such is only for cases, not prophylaxis and nowhere near enough) and vaccines will take at least 6 months?

I even know doctors that said they won't work thru it. They will close their offices. Even ED docs who have said no way, they wont put their families at risk.

indigo girl · Dec 3, 2006

I just finished reading the Pandemic thread II. Well done, Indigo Girl!
I dont think that my hospital is prepared at all. I find that scary, both for myeslf and my coworkers and the community we are pledged to serve. unless we prepare I dont see how we can keep the doors open.
Why? In the ED I work in, very very few nurses (like ONE!) have stated they will work in a pandemic thats as bad or worse than 1918. I personally have reservations about staying past the point that the PPE is gone if were looking at a high CFR (Case Fatality Rate).
Right now, the CFR is about 60%.
I'm dedicated, but not stupid!
So I'm planning on personal preps to see us through a bad one, and that's concerning to me.
Do you think nurses will stay on the job if the CFR is high, and theres no antivirals (After all, the national stockpile of tamiflu, relenza and such is only for cases, not prophylaxis and nowhere near enough) and vaccines will take at least 6 months?
I even know doctors that said they won't work thru it. They will close their offices. Even ED docs who have said no way, they wont put their families at risk.

There have been nurses on this board who have said that they will work, even nursing students. My thought is that you may not have a choice.

Your license may be at risk if you do not work. They may excuse those who are caring for sick ones at home, or have no childcare due to school or daycare closure. Then there is the guilt factor, and of course, your neighbors know that you are a nurse. Can you really stay home if no one is sick at home?

Would you not expect government to get involved, like it or not, and send resources, like us, where they have determined we should go? I expect the decision will not be up to me.

My ex-husband, a pathologist, who runs a Red Cross blood bank in a large

east coast city, expects that he will be working, like it or not. He also expects to be involved in any emergency planning.

If you look at the pandemic influenza plans for your state, you might see that they will be accepting volunteers, retired healthcare workers, and anyone else to help feed, bathe, whatever is needed. Now realistically will they get those volunteers? I just don't know.

Personally, I think most people on this board will be working. Why I think that, I can't say exactly except that I have a lot of faith in my most excellent colleagues. I believe that they will provide the necessary care.

There is no one else to do this job.

LMonty911 · Dec 3, 2006

I know nurses that have made arrangements to leave home and take their families to another place so they cant be held and forced to work. More than one. When I tried to talk to the former ED director about it, she said "If it happens, I'm outta here".

So i applaud yuor optimism Indigo, :) but I'm not holding my breath. Maybe I'm pessimistic about or rather, I'm optimistic if we all get educated and prepared, but I dont see it happening yet.

Try it, ask some of your coworkers is they will come to work with high CFR pandemic- like 10 or 20 % mortality. Or how many will drop out when the absentee rate goes to about 25%> How can we take care of 3 or 4 times more patients with 3/4 to 1/2 the current staff?

I dont think we can.

I would love to see what responses folks get, especially in different areas of the country or different areas on practice. Is there an age or expereince difference in the responses? Will we be surprised with the answers? I think we will. Maybe its just my region that will be SOL or perhaps its widespread.

Even if the nursing staff holds steady...what will work be like if ancillary departments start running at 1/2 staff? Somehow I doubt the admins will be mopping floors and running the laundry and changing light bulbs or cooking lunch for 500-or will they?

Heres an interesting snip for a website. THey have a great video about one the recent public conferences TPTB held to determine planning and education initiatives....that was just great...

Preparedness & Response

An acute catastrophe, affecting one city (such as New York) or one region of a country (such as the Gulf of Mexico region) is difficult enough to respond to at a local and national level. Now imagine that every community has their own 9/11 or Katrina to deal with…at the same time. Welcome to the avian flu pandemic, coming to a town near you. The country rallied around New York during 9/11. Millions of people donated money, goods and services to the victims of Katrina. But who will I reach out and offer help to when I’m dealing with my own local disaster? Will I be competing with other people and other communities for supplies and aid? Will my darwinian instincts kick in??

Consider the distribution of supplies that will be needed in large quantities during a pandemic outbreak, such as ventilators to help people breathe in case of lung failure. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University School of Public Health, recently wrote a book, Americans At Risk, Why We Are Not Prepared For Megadisasters And What We Can Do Now, that highlights just how unprepared we are for an avian flu outbreak. Dr. Redlener uses simple math to connect the dots:

In the United States, there are about 105,000 ventilators. On any given day, some 80,000 are in use across the nation. During the typical flu season, this number may rise to about 100,000, leaving only about 5,000 in reserve for the whole country….A moderate-sized metropolitan area would use that many in a few weeks of a major pandemic flu season. The actual need for the U.S. stockpile could be 750,000, seven times what we have.

With short supplies, who will be looking out for whom? Can we do anything in advance to prepare so we’re not all competing for finite resources??

The conclusion of Dr. Redlener’s book is yes we can. We need to spend some time and money in advance of disasters that may or may not happen, but not much. He offers simple game plans that can, while not averting disasters, at least reduce their impact.

Recently, Frank Peacock, Chairman of Emergency Preparedness at the Cleveland Clinic, ran a hospital-wide pandemic flu drill and came to some startling conclusions about the Cleveland Clinic’s ability to deal with a pandemic flu crisis. For example:

- What happens when you get 10,000 patients a day coming into the emergency room?

- What happens when 1/3 of your staff doesn’t show up for work?

- What happens when hospital food delivery is down by 40% because 1/3 of the truckers didn’t come to work?

- What happens when picketing is taking place outside the hospital because of limited vaccine supply?

- What happens when the hospital runs out of N-95 respiratory protection masks?

- What happens when three members of the upper management of the hospital die?

This is a scenario that was played out in one hospital in one city. Play that scenario out in EVERY town in the country, add every hospital, fire department, police department, school system, news bureau, and public transportation network, and you get the point. Now consider that most people will stay home to avoid catching the virus and to take care of family who are sick, and we’re looking at over 40% absenteeism rates at work. What kind of crisis management and, more broadly, economic consequence will that have??

If anything, Katrina taught us, or if not me, certainly the people who live in the Gulf Coast, that there is no safety net to rely on in an emergency situation. The government, even after 9/11 and Katrina, is still a bumbling bureaurocracy that will, at best, be the last person showing up to the party, the fashionably late socialite.

When I asked Jason Irvine, who was working at a medical facility in New Orleans when Katrina hit, what single thing the federal government could have done better (among the many things it could have done better), his response was information sharing, letting people within the affected community and outside know what is going on, offering recommendations and advice, and generally acting as air traffic controller.

ScribeMedia » Darwin Meets His Match - From Stuffy Nose to Pandemic

indigo girl · Dec 3, 2006

That video was well done, thank you, L.Monty.

Perhaps you are correct about the numbers or lack there of HCWs, who will

work. I have spoken to some recently outside this thread, who have indicated that their families come first. I can not argue with that reasoning.

If you have children who need you, OR if you are pregnant, really, your obligations are elsewhere, and that is very understandable. It is not for me to judge anyone on their decision as to whether or not they will work. I know that I will be working and perhaps my asthma will mitigate that cytochine storm if I get infected, and/or the specific herbal remedies that I have researched will protect me. I have to believe that. I am increasingly cautious now around any sick patients, but it is the staff, and the people that you don't know are sick that are the problem.

indigo girl · Dec 3, 2006

One more thing, I will not work without the PPE (personal protective equipment). You can not ask that of anyone. So hospitals and nursing homes, I hope you are stocking up!

oramar · Dec 4, 2006

I have mentioned this in past. In the flu epidemic in the early 19th century, people were acustom to dealing with illness at home. Most of the that died, died at home and the survivors were treated at home. In the USA people have this sense of entitlement, they will all go to the emergency room and will all demand to be seen immediately. The situation will be very, very difficult. My opinion is that the time is NOW to educate the public that in an epidemic the last place they might want to be is an emergency room. Perhaps there should be teams that will visit people in their homes. If you promise people help will come to them maybe they will be less likely to flood ERs. Remember, there will still be accidents and appendectomys and burns and many other types of illnessess non flu related. The death rate in nonflu emergencies might be very high because they will not be able to get through the crowds to get help.

LMonty911 · Dec 4, 2006

If you promise people help will come to them maybe they will be less likely to flood ERs.

good point! how about an expanded telephone triage, that tells people how to care for symptoms at home for those that dont require the ER- or is able to triage those that do need to see a provider, and sends them to a clinic area for the less serious stuff, and the ED for only the very worst cases involving poss pneumonia?

Ive used a great telephone triage computer program that has algorythms telling you what questions to ask for each chief complaint, and what response to give along with what level of care and/or referral they need, and has home care instructions for stuff that can be taken care of at home (fever care, etc). A similar set up like that would save many visits much money and help decrease iatrogenic transmission in the waiting or care areas. Not to mention, nurses that wont/cant work the hospital could do that from home, thereby augmenting the work force and relieving ER's/Clinics of a lot of unneccessay visits. Canada has something similar as part of their planning, IIRC, based on their experience with SARS. It works...

another excellent observation, oramar:

The death rate in nonflu emergencies might be very high because they will not be able to get through the crowds to get help.

Pandemics have historically come thru communities in 8-12 or even 16 week waves. The attack rate (% of population that become ill) can easily be 30-40% (in some areas in 1918 it was much higher) for the wave.

As flu goes thru a community, illness rates take a bell shaped curve. about 2 weeks after it starts IIRC, there can be about 3%-5% of the population infected, and at 4-6 wks or midwave, depending on wave speed, there can be as many as 10-15% of the population ill at one time. Figure one week for each ill person to recover, longer if they have pneumonia or complications.

Thats how much of the workforce may be out at one time, as much as 15%. Dont be surprised if at least as many refuse to work from fear of illness. Not just in nursing but EVERY job and profession. That means illness of as much as 10%-15% or more and additional absence rates of ambulance personnel and first reponders- i expect twice that easy, since they are at very high risk of respiratory and fomite transmission in such an enclosed space as the ambulance during transport- and from what i hear, very few services are stocking PPE at all, or enough to last long enough to cover the 2-3 months of even one wave.

There could be three or more waves!

Triple or quadruple their calls due to increased demand- when 25% or more are out of work, how will that affect response and on-scene treatment times?

They will be bringing patients in to the hospital with the same type of absentee rates among staff and physicians- What will that do to our non flu emergency patients -traumas, MVA's, cardiacs, respiratory emergencies, asthmatics, etc? The folks who really need immediate treatment....what plans can we make to mitigate the delay, and reduce the inherant increased mortality from such an issue alone? And how do we keep them from getting infected? Remember that the flu effectively transmits AIRBORNE, FOMITE and DROPLET,and victims are contagious to others at least 24 hrs BEFORE symptoms break. Virus lives on surfaces for up to several days, depending on the conditions (longer the colder it is) Every well appearing person you are in contact with can be shedding live virus-or every healthcare worker that looks well could be contagious to their non-flu patients and visitors and other staff, too...

Someone recently said to me "We'll just go on diversion and let the other hospitals handle it until our staff is back".

NO ONE will be able to divert even if there are no beds, since NOONE ELSE will have beds. Lack of power or OR capability may be the only justifiable reason to divert.

Obviously the nurse didnt yet understand that pandemic everywhere at once, and we are all going to be in the same boat, bailing like crazy....we're just not used to worldwide disruptions, and havent as a profession or even a nation gotten it into our heads that we really are on our own, and the cavalry aint coming!

The morbidity and mortality in our communities, from flu and assosciated social problems. Ever get a dozen CO poisonings in one might becaue the electricity is off, and folks are using unsafe combustion heaters, then get smoke inhalation cases with burns because folks get careless and burn their houses down with candles? I have. Not uncommon in the Carolinas where I worked when the power was out after ice storms.

C'mon, guys, we need ideas! What can we do? How can we paln to deal with this, and set up systems and preps in advance for our hospitals, communities and families?

With all the experience and professional knowledge on this board, can we come up with viable suggestions on help mitigate the problems we are going to face?

I bought a couple of boxes of nitrile gloves from the hospital pharmacy, and some N95 masks. Lots of hand sanitizer. Enough OTC flu meds for the family and to share with neighbors if needed, and vitamins/supplements that might be helpful for the close family. So, even if the hospital runs out, I have enough PPE for myself for awhile longer. If the doors close (which I really do consider possible in some places) I have enough to take care of sick family and neighbors and reduce my own risk a bit. I talked my PMD into giving us both the pneumonia vax, to decrease the chances of secondary infections (still a risk, even if you dont get cytokine storms, and very scary if the antibiotic stocks dont hold out) even though we are both only 50. I have enough food to get us through a wave, even if its not too appealing and a bit thin if the waves last the longer time. And some to share, even if its just basic staples.

What else can/should I do to be prepared?

How can I /we help encourage preps at our facilities and in our communities?

beachmom · Dec 4, 2006

I work in a 150-bed hospital in pediatrics. We ship out all our peds ICU pts. Our hospital recently participated in a mock pandemic.

My manager wrote out all these elaborate plans of what to do. One of the plans was to turn the respiratory department into a peds ICU with four ventilators. (Resp. is next door to peds.) However, I don't know where he's going to get the nurses to run the ventilators. None of us have ever been trained on them. None of us have worked with ICU pts. I guess he figures we'll get an inservice when the pandemic hits. That's scary.

I'm glad they're planning, at least.

It would be a good idea for us nurses to stockpile our own PPE. If the hospital runs out and they are forcing you to work, bring your own from home.

augigi, CNS · Dec 4, 2006

Trained staff to run ventilators will be one of the biggest problems I imagine. I would not work without PPE, and I don't think I should have to provide my own - if they force you to work, they have to provide a "safe" workplace.

indigo girl · Dec 5, 2006

Trained staff to run ventilators will be one of the biggest problems I imagine. I would not work without PPE, and I don't think I should have to provide my own - if they force you to work, they have to provide a "safe" workplace.

This think tank addresses the ventilator problem, but I am not sure how realistic this would be. They believe that we will volunteer to do this. But, will we?

http://www.fsround.org/publications/pdfs/PANDEMICFinal.pdf

http://www.fsround.org/publications/pdfs/PANDEMICFinal.pdf]
The Public Health Service is ideally suited to oversee the implementation of a
national program to train and certify medical professionals – most likely current
nurses and paramedics and retired or former medical personnel – who are not
already certified to operate ventilators so that more personnel would be available
to carry out this function in a pandemic emergency. The training could be
commenced very quickly through local hospitals and health care organizations.
We believe that many health care professionals would volunteer to help in this
fashion in a pandemic, if also provided with appropriate protections against
infection in the form of anti-viral medications and respirators.

They seem to be saying that we would be protected by anti-viral meds,

however, I know that my state's pandemic plan does not include prophylactic

Tamiflu because there is not enough. We will only be given Tamiflu if

we become infected (if there is any left, that is). I am glad that I know

this in advance. I want to make my decisions based on as much information

as I can gather. I have noticed that states have differing plans so do check

your state's plan.

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