Published
I was looking the the other Disaster/Pandemic thread that Florida1 started. She mentioned that after the hurricanes, that they had problems getting basic supplies and food stores were often closed for weeks after the storm.
That concerns me. I wonder in case of disasters like hurricanes, earthquakes and pandemics if the nurses who work in the area have problems like that. I'd be worried about leaving my family if there was no heat or electric. After loosing electric in the ice storms in the Carolinas a few years back, my husband bought us a generator. I try to keep enough gas stored so that I could run that and maybe have an extra tank of gas for getting back and forth to work, if things were shut down. I never want to wait in the cold on those gas lines again; or have to risk driving around to find necessities!
What disasters have you been through? What lessons did you learn about what things would make life easier if it happens again to you? What can we learn from your experience, and how can we prepare for so we dont have to go through th esame problems you did?
Where there any sepcial tricks or issues that came up that helped you at work? Any special problems that nurses in disasters face?
I have a confession- my home first aid kit is pretty anemic right now :) DH burned his hand prety badly at work last week. I hadnt checked my kit in awhile, and was shocked to see how low I was on some stuff. I only had one roll banfage and had to make a run to WallyWorld the next day! If the stores were shut or the roads iced in or otherwise impassible that would have been an issue. Maybe not life threatening- but its a small example of how not being well prepared can be a problem.
I'd have been so embarrased to admit to hubby I couldnt take care of it, or come thru when he needed me to.
What do you do to prepare? I'm going to restock my kit, and get some more OTC stuff to keep on hand too. What else should I be thinking about?
Laura
Pandemic Issues For Home Health Providers - Pt 1
There are many communities that have very little home health
coverage at this present time. For example, in eastern Connecticut
there is so little home health care available currently that most folks
recovering from total knee replacements who could have done fine
at home, had to go to nursing homes with skilled rehab for their care.
If they had lived in Philadelphia, they might have received home care
instead.
Expectations for home health agencies during a pandemic do not
include caring for flu victims unless they are already home care patients.
That is not a possibility. There are not enough agencies and staff
providing care now, and there will be even fewer staff providing care
during a pandemic.
So what will be the role for home health during a pandemic?
Optimistically, it looks like the govt might be expecting them to fill
in the gaps, caring for people being discharged home from the hospital
early in order to free up beds. If anyone would take the time to read
your state's pandemic plan, you might see that this anticipated role
has been the plan all along. The real question that needs to be
answered is, how will they do more with less? If that question can
not be answered, than the plan is useless and can not be implemented.
No matter how you look at it, those discharged patients are not likely
to get much care.
http://afludiary.blogspot.com/2008/07/pandemic-issues-for-home-health.html
...this report identifies two primary receivers of home health care
during a pandemic.
Those medical and surgical patients, not hospitalized because of the
pandemic, who are well enough to be discharged early from hospitals to
free up hospital beds for more severely ill patients.
Patients who become or already are dependent on home health care
services (predominantly elderly persons with chronic disease) and will
continue to need in-home care during the influenza pandemic whether
or not they become infected with the influenza virus.
Accordingly, the home health care industry will be asked to handle their
current patient load, plus the addition of surgical and medical patients
discharged early in order to free up hospital beds during a crisis.
This at a time when their own ranks may be severely depleted due
to absenteeism.
pandemic issues for home health providers - pt 2
http://afludiary.blogspot.com/2008/07/pandemic-issues-for-home-health_12.html
who will pay for all of this in advance of an actual event?
i can see these agencies becoming leased by the govt or commandeered
during an event in progress as that may is the only way they will stay
afloat and provide at least some of the care envisioned in this report.
it is probably the only way that they will be supplied also.
`.... supplies specifically needed for surge patients
and supplies for surge and existing patients that are not usually
provided, such as food, water, or medications.'
finally, agencies need to ensure that their workforce has the essential
protective equipment needed to safely care for patients, including
niosh-certified n-95 filtering face-pieces or higher rated respirators
as feasible.
the assumption that during a pandemic, supply lines will continue as
normal, is seriously in dispute. there are good reasons to believe we
could see prolonged shortages of many goods, including disposable ppe's
such as masks, gloves, and gowns.
pandemic issues for home health providers - pt 3
http://afludiary.blogspot.com/2008/07/pandemic-issues-for-home-health_13.html
surveys indicate that a significant number of health care workers may
be unwilling to report to work during an infectious disease-related
emergency.
the new york city survey cited above indicated that less than half (48
percent) of the workers would be willing to report to work during an
infectious disease outbreak...
the most commonly cited reasons that workers gave for not being willing
to respond to an emergency included fear and concern for their own and
their families' health and well-being (31.1 percent and 47.1 percent
respectively).
Booster vaccination may help with possible future avian influenza pandemic
http://www.eurekalert.org/pub_releases/2008-07/idso-bvm071608.php
New evidence suggests that a booster vaccination against H5N1 avian
influenza given years after initial vaccination with a different strain
may prove useful in controlling a potential future pandemic. The study
is published in the August 1 issue of The Journal of Infectious Diseases, now
available online.
...as the virus continues to mutate into genetically distinct lineages, or clades,
the problem arises as to whether vaccines based on an older clade will be
effective against newer versions. The new study is the first to report that
giving one dose of a newer-clade vaccine to those who were vaccinated
previously with older versions is more effective than giving only doses of the
newer vaccine to unvaccinated subjects.
The results not only support the booster technique, but also show that even
though the virus had mutated since the initial vaccination, using it to boost
an earlier vaccine is more effective than simply vaccinating subjects with the
most current vaccine. These findings are important given the fact that
influenza viruses are mutating constantly.
"These results suggest that one strategy for pandemic control could
involve prevaccination of some segments of the population prior to the
emergence of a pandemic so that effective protection could be achieved
with a single dose schedule if and when a pandemic emerges," the
authors wrote.
In an accompanying editorial, Gregory A. Poland, MD, of the Mayo Clinic
College of Medicine, noted that some are already looking to begin such
prevaccination primers against H5N1 influenza. For example, Japan is
planning to immunize health care workers starting in 2009, and the U.S.
Department of Defense is offering a vaccine to those in high risk
specialties.
"determining who should receive these vaccines, when, and in what
order and under what circumstances deserves widespread debate,"
As of mid-June, 60 percent of the more than 380 human cases have
been fatal, and half a billion birds have died or been culled to prevent the
spread of the disease.
(hat tip flutrackers/ironorehopper)
HHS Guidance on Allocating And Targeting Pandemic Influenza Vaccine
Please understand, once a pandemic is declared, they are saying that it
will take 20 weeks for a vaccine targeted to the specific flu strain occurring to
be ready to roll. That's 5 months to begin vaccinating the available amounts
of vaccine going first to the most at risk population which is prioritized by
factors such as age, occupation, pregnancy, and this is modern medicine
at its finest which is why we should be concerned.
http://afludiary.blogspot.com/2008/07/hhs-guidance-on-allocating-and.html
Today we have the long-awaited release of the HHS's (Dept. Health and
Human Services) guidance on pandemic vaccine allocation called
Guidance on Allocating and Targeting Pandemic Influenza Vaccine.
...a targeted pandemic vaccine won't begin rolling off the production lines
for 20 weeks, and then, only in limited quantities.
... the availability of a strain specific vaccine for a pandemic will be extremely
limited during the first six months, and possibly longer, into a pandemic crisis.
Anytime you have to prioritize who will receive a potentially life-saving vaccine
first - and who will have to wait - there will controversy. No plan is likely to
please everyone.
Some State Preparedness Messages
Just looking at how some states have tried to prepare their citizens,
it becomes obvious that the next pandemic is not only expected, but that
there is real concern that it will not be mild as in 1957 or 1968. The very
fact that a highly virulent bird flu virus currently is present in birds on three
different continents, and that it has jumped species to infect mammals
including humans increases that risk.
Here is a video from California, a state that is at the forefront of the
preparedness effort. Human to human transmission of H5N1 was unknown
in 2006 hence the remarks that it had not happened yet. That has since
changed, and some suspect more frequently than is publicly acknowledged
as the existence of clusters of cases in places such as Indonesia and Pakistan
might indicate.
Secretary Leavitt of HHS is telling it like it is. Pandemics are part of our
biological history. They have always occurred, and they always will.
Nothing can change this fact, not modern science, not Big Pharma, and not
modern sanitation. Our only defense is to be prepared as best as we can.
http://www.youtube.com/watch?v=RXtmjTXm2Ng&feature=related
Will edgy messages be enough to get the public's attention as in the
PSAs mentioned in the following link?
Florida pandemic flu drill dead-on with projections (so to speak)
Commentary on a recent pandemic flu exercise in Florida from
Scott MacPherson, CIO of the Florida House of Representatives.
This exercise involved a case fatality ratio of only 2%. If it is
the H5N1 virus that we are hit with, it's current CFR is over 60%.
Something, unpleasant to consider, but should be kept in mind.
Exercises never use this figure...
...the issue of 16,000 new orphans arose during the simulation. How will
Florida cope with 16,000 new orphans? The answer was not forthcoming.
And that is fine for now: As long as the question is asked in a public
setting, the answer can come later. Just get someone thinking about that
and get back to him quickly.
Equally comforting in its bluntness was the estimate of 100,000 Floridians
dead from pandemic influenza. That is in line with HHS projections for a
2% case fatality rate. Eighteen million Floridians, at a 30% attack rate,
with a 2% CFR ..... right on line with the scenario. There was no attempt
to lower the CFR; no attempt at a happy ending.
Many eyes were opened during the exercise. According to the Miami
Herald, Governor Charlie Crist looked up at Fugate and asked, "Could this
really happen?"
Fugate's measured response: ''Unfortunately, that's what science tells us.
Do we want this to happen? Pray it never does. But we have to ask, what
if it did?''
Updates in Pandemic Planning for Japan
http://afludiary.blogspot.com/2008/08/japan-health-ministry-seeks-major.html
In another sign that global concerns over a pandemic have not lessened,
Japan's Health Ministry is seeking nearly a 10-fold increase in their
pandemic budget for 2009.
Japan's government has been very proactive in pandemic preparedness,
acquiring antivirals and pre-pandemic vaccines, while the private sector
in Japan has been less inclined to prepare.
http://afludiary.blogspot.com/2008/08/japan-plan-to-add-3600-ventilators.html
Plan To Add 3,600 Ventilators in Japan
... at least part of that funding (2 Billion yen) would go towards increasing
the number of ventilators (or `respirators', as this article calls them) in
medical districts around that nation.
Uncovering Influenza's Achilles Heel
http://afludiary.blogspot.com/2008/08/uncovering-influenza-achilles-heel.html
Basic research is where it's at. Some day in the not too distant
future, this research will pay off. I hope it is sooner rather than
later. We need to understand how influenza infects cells to
develop effective defense strategies against it.
This is a very important piece of work.
The researchers have determined the three-dimensional structure of a
site on an influenza A virus protein that binds to one of the human protein
targets, thereby suppressing a person's natural defenses to the infection
and paving the way for the virus to replicate efficiently. This so-called
NS1 virus protein is shared by all influenza A viruses isolated from
humans, including avian influenza, or bird flu, and the 1918 pandemic
influenza virus.
... the NS1 protein binds a human protein known as CPSF30, which is
important for protecting human cells from flu infection. Once bound to
NS1, the human protein can no longer generate molecules needed to
suppress flu virus replication.
Pandemic PPE for the Japanese HCW
First of all, I can not imagine working in this kind of get-up, but I
would wear it if I had it available and I were being exposed. And, second,
who is going to provide this? Not my hospital, since they already think
they've got everything under control for any eventuality. Running out of
O2? Not to worry, we will be resupplied by barges on our island fortress.
But what happens when the suppliers run out? No answer because the
planners have not considered it or maybe there is some other plan that
no one has mentioned...
Anyway, this is what Japan is doing for protective gear, and they are
also talking a lot about plans to inoculate staff with a prepandemic H5N1
vaccine so much so that it would appear that they are really going to do
follow through with these plans. This vaccine is in limited supply and is
based on an older strain of virus. No one knows if it will prevent infection
with the pandemic strain, whatever that may happen to be, but the thinking
is most likely that it will prevent mortality if not infection.
Quite a contrast between what is happening there and what is happening
here. Perhaps, actually knowing that bird flu has invaded in your country
more than once, and will most likely reappear again gives them the
necessary impetus to implement action in advance of a pandemic strain's
appearance. That, and the continued evolution of the H5N1 virus, as well
as the not so far away problem of Indonesia unremittingly hiding cases of
bird flu in humans though the last large outbreak scared even them enough
to call the WHO back in for help.
Sure, it's all based on a possible event, but history is full of these events
and there is no plausible reason to think that Mother Nature will stop
producing pandemic viruses no matter how sophisticated our modern
medical techniques and knowledge. We still can not prevent it from
happening though we are currently using many delaying tactics and
using our weapons effectively such as they are. Culling of sick or
potentially sick poultry, treatment of infected humans and use of the
Tamiflu blanket for those exposed to them or sick poultry, have been
successful thus far. We have had luck on our side when Tamiflu
resistant strains have occurred in that those strains have not been
more easily transmissible to humans yet. But, the very fact that this
resistance has occurred is why we should be thinking like the Japanese.
Human to human cases have occurred, and they will again because they
can. The concern is that some day, H5N1 will get it right, with a drug
resistant, easily transmissible strain,and then we will be dependent on
our mitigation strategies to protect our population with no vaccine, and
not enough of anything from PPE, to Tamiflu, beds, vents, O2, or even
antibiotics to treat the resulting cases of pneumonia. What are we
going to do then that we could have done now?
http://afludiary.blogspot.com/2008/09/what-well-dressed-hcw-will-be-wearing.html
The Downfall of Just in Time Delivery
http://afludiary.blogspot.com/2008/09/supply-chain-of-fools.html
One of the most effective voices urging that we take strong steps to
address supply chain issues during a pandemic- particularly for our
coal fired power generating facilities -is Dr. Michael Osterholm of CIDRAP.
He makes the case for other industries, including offshore
pharmaceutical manufacturing, PPE's, and other critical supplies as well.
If you have never listened to one of his presentations, I would urge you
to seek one out.
Next week Dr. Osterholm's presentation at the The Pandemic Threat:
Preparing an Organizational Response conference should be available online.
http://afludiary.blogspot.com/2008/09/reminder-hhs-telecast-on-personal.html
It is actually amazing that the govt is reaching out to give citizens
this information. Too bad they are not making more of an effort
to promote it. Hardly anyone will ever know that they are doing
this. If you really want to reach people, you have to be willing to
go the extra mile, and put the message where they can not help
but see it as in PSA's during prime time, bill boards, magazine ads...
Why not really do the job you say you are trying to do, which is to
educate? It kind of gives a mixed message when compared to what
they did to educate about AIDS or even to try to reduce cigarette
smoking. There is no question that the govt is serious about the
pandemic preparations to the tune of millions of dollars. They do know
that it is inevitable, just not how bad or when it will happen.
Contrasting what is happening here with what the Japanese are doing.
I best understand the difference in response by noting that Japan admits
to H5N1 outbreaks occurring in their country in the last few years. They
probably feel much more threatened because they are so much closer to
the problem. They know it is coming back, and they suspect that it is going
to be a serious problem at some point. The Koreans had a very difficult
time trying to stop it with the last outbreaks, and they are close by.
The latest in a series of PlanFirst Webcasts from the HHS is scheduled to
take place later this week, on September 25th, at 2pm EDT.
This month's broadcast will be on individual preparedness for a pandemic.
You may submit your questions via email prior to, and during the broadcast.
indigo girl
5,173 Posts
An Aussie vet heads for Vietnam
http://crofsblogs.typepad.com/h5n1/2008/07/an-aussie-vet-h.html
This story is a great example of what needs to be done to prepare
globally for the next pandemic. Send help where it is needed now.
The hot zone countries gain by having the expertise of vets trained
in public health measures. The non infected countries gain by
having scientists gain first hand experience dealing with avian influenza.
Mutual assistance and cooperation wins out over censorship any day.