Are you prepared for Avian Flu?

LMonty911 · 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.

Yes, they CAN force you to work-executive order- and no, they dont have to provide the PPE if it runs out- they simply can't at that point.

It doesnt necessarily mean you get to go home.

It does mean theres a real likelyhood the rules change. And I'll bet we wont like those changes...

augigi, CNS · Dec 5, 2006

Yes, they CAN force you to work-executive order- and no, they dont have to provide the PPE if it runs out- they simply can't at that point.
It doesnt necessarily mean you get to go home.
It does mean theres a real likelyhood the rules change. And I'll bet we wont like those changes...

I am actually in Australia, and was quoting according to our occupational health law, which is completely correct. I can not be forced to work in an unsafe environment.

Re retired/general staff running ventilators - that's all fine, but they still haven't trained anyone - when is that meant to happen?

The ventilator manufacturers must LOVE avian flu!

indigo girl · Dec 5, 2006

Yes, they CAN force you to work-executive order- and no, they dont have to provide the PPE if it runs out- they simply can't at that point.
It doesnt necessarily mean you get to go home.
It does mean theres a real likelyhood the rules change. And I'll bet we wont like those changes...

Luckily for that poster that they live in Sydney, and won't, one assumes, be subject to executive orders.

We need to speak to our facilities about acquiring the necessary protective equipment. They can not expect us to put ourselves on the line without it.

I would tell them flat out, do not expect staff to work without protection.

As for prior planning, I know of a corporation that runs nursing homes, where the nursing staff have all been fitted for N95 masks. That is realistic planning.

indigo girl · Dec 5, 2006

Check out the Pandemic Response Plan for Connecticut, look under

Duty to Provide Care:

http://www.dph.state.ct.us/avian/CTDPH%20pan%20flu%20plan%202-feb-2006.pdf

"In our society, both institutions and individuals will be entrusted

with governance over scarce resources, such as vaccines, antivirals, ventilators,

hospital beds and even health care workers."

We are considered to be part of those "resources".

1Tulip · Dec 5, 2006

We had H5N1 here in 67 and 68. I was in nursing school and was majorlly sick, fever out the roof, lungs full of concrete. But being young, I survived. Now the story would be different since I have reactive airway disease. I don't suppose anyone knows if earlier exposure to H5N1 confirms any immunity.

This pandemic is going to be different and not as deadly as the 1918 because there's not a trench war going on where young men are vastly exposed, then transported home to infect families and towns. We have the antibiotics to deal with the secondary bacterial pneumonia, we have steroids and sophisticated ventilators.

It won't be 1918 again... but it will be pretty bad.

Princess74 · Dec 5, 2006

If this pandemic happens when is your best guess on a time frame. I have not been following this avian flu thing. Just trying to catch up and educate myself. I'm in the process of reading the huge thread on it now.

LMonty911 · Dec 5, 2006

augigi, thanks for the correction! I apprecicate it, sorry for my error.

and I admit- I am a bit jealous :)

Tulip, the pandemic in the 60's wasnt H5N1 it was another strain, H3N2, and that was about the first it circulated widely, and was believed to be created by antigenic drift from the human circulating H2N2 that it replaced. Because it was antigenically related to an already circulating human virus the impact was less than a virus which jumps rapidly into humans. Part of the reason anyway, but virulance seems to be a combination of factors, some genetic in the virus itself (like receptor site amino acid sequences), and some related to host susceptability.

Steroids are no longer recommended for ARDS, and have been shown to increase mortality. They had no beneficial effect on recent H5N1 victims. No help there.

The flu is such a promiscuous virus and mutates so rapdly, that you can have a strain one year, and still catch the same named strain the following- it may have changed just enough to outwit your immune system. Thats why flu vaccine is reformulated every year, to include the most current and likely to be circulating strains.

Anitbiotics- yes, that's a definite plus! It should help reduce the deaths caused by secondary pneumonia.

But H5N1 is currently killing via primary bacterial influenza pneumonia not secondary. Antivirals like oseltamivir have shown some benefit, but need to be started within a day or two of infection to be most effective-by the time the cytokine storm hits, they apparently have little beneft.

So yes, we do have lots of good things now- we know a lot more about infection control and how to avoid getting sick. We have PPE. We have antibiotics. We have ventilators.

And nowhere near enough of any of them. Estimates by some planners are they current stcoks are good for about 2 weeks if we are lucky. Waves last 60-12 weeks or longer and can recur two or more times, with a few months in between. After those supplies go, we are back to pretty close to what they could do in 1918-supportive care, and hope for the best.

It doesnt have to be 1918 again- it could be much worse. Theres no guarantee that 1918 was the worst pandemic and things cant be worse, and soem researchers feel older pandemics have had even higher mortality rates than 1918. I sure hope it isnt worse, dont get me wrong , I am hoping for the best while preparing for the worst! if we get very very lucky, maybe it will be mild like 1968 or 57.

The longer I watch and learn about this, the more convinced I am that we need ot be proactive and prepare. Its not going to be business as usual evening a mild pandemic, health care has changed so much since the mild one in 68 that it will have huge impacts on HCW.

A serious or severe pandemic could be devastating. We cant stop it, if it does jump but we can prepare and mitigate the impacts on our communities, facilites and our families.

LMonty911 · Dec 5, 2006

princess- recent estimates are that H1N1 was kicking around in small clusters for about 10 years before the 1918 pandemic broke out, thats by retrospective study on the samples available, old public health data, and of all things bird specimens collected and kept in museums!

We just dont know when. We do know that the experts think it could happen with only one or two small mutations. the virus has alredy made several mutations away from the genetic structure that kept on the other side of the species barrier, and grown much closer to human flu sequences. That means we are only a couple of amino acids away from a pandemic.

I havent yet found a professional who will estimate it. But since last year, many of the pros have changed their statement from not "if" it breaks out, to "when it breaks out". They have become much more concerned and many are prepping.

Even Dr Webster, one of the worlds leading flu experts from St Judes, has recently admitted he has prepared his family with food and supplies for 6 months.

Princess74 · Dec 5, 2006

Thanks LMonty911.

Mary J · Dec 6, 2006

hi all!

i'm currently working in home health in alabama..i've been studying/following avian flu for about a year.

the best book i've read on avian flu is bird flu - welcome just released/

written by michael greger, md

director, public health and animal agriculture

the humane society of the united states

it's free, on line e-book with excellent sources, links-very well written with great info on all aspects of avian flu.

it will scare the stuffing out of you.

many, many quotes by experts from all fields, and great in depth info about 1918 flu.

it's made me move to really getting prepared on a personal and professional level.

i believe we will need to educate and organize our communities to survive this if it happens.

there's no other way to deal with this issue.

he is donating all proceeds from hard cover sales to charity and will answer any questions by email.-very nice man-very importatnt resource for professionals and lay people alike.

mary j

LMonty911 · Dec 6, 2006

Mary, its a great reference! I'm so glad to see you sharing it.

and so glad to see you preparing! I hope more are, even if they are too shy to share....

Dr Greger recently joined us as a member at Flutrackers. His expertise being made avialble to the public thru this book is a great contribution to public readiness! Ya gotta love it when hes donating all the money, I sure do! you kno whe hasnt got any agenda expcept wanting people to get prepared and decreasing morbidity and mortality.

Alabama_Medic · Dec 6, 2006

I am the Employee Health Nurse at Flowers Hospital Dothan, Alabama. I am also on the Pandemic Flu planning committee. HHS & CDC are espousing the use of phone triage to limit the amount of unnecessary ER visits for hangnails, back pain for 7 years and so forth during the surge of pandemic flu patients. Our hospital policy prohibits, as does most, the giving of medical advice over the phone. Now I understand that once most disaster/flu emergency response plans are activated most rules are out of the window but I would appreciate any and all responses on your policy and your opinions on the phone triage subject as well as the official stance your facility is taking. Please include your facility name and your title if possible.

Thanks and God Bless,

ETC