For Doctors, Nurses, and other medical em - Event Date: August 19 2006

Have the doctors live in designated motels away from family for the duration.  The state will commondere them for this purpose.

(Gardener: if you read this thread - this is why IMHO those that serve AND their families, have to be given first priority for prophylactic treatment. If someone serves society in any capacity that has been deemed crucial to this event, they should be protected as much as possible.)

4abbie&maddie: What a heartfelt post! I hear your desperation and your bravery! We are all going to be on the front lines when this hits. Exposure to one sick family member will do the same amount of potential damage as 100. Realistically, SIP will only work for a short period of time unless you are Bill Gates and have been able to create an island for yourself. Most of us do not have that option. Someone on the front lines of the medical profession will have as much exposure as a retail worker who mans his post, as a truck driver who stays the course to deliver food and water, and as the grave digger dealing with bodies. And we will all come into contact with asymptomatic carriers.

We are all in this together, and we are all afraid.

As of right now  does anyone know how infective the virus is in light of universal precautions?  As a dentist, I'm exposed to the mouth 24/7 with lotsa water spray, blood, saliva etc.  I think I'll only open for true emergencies, and offer palliative care at that.  I would not ask staff to come in.  Are there any other dentists out there?

wartning, long rambling, slightly emotional post ahead.

4abbie&maddie,

I feel awful for families of physicians and nurses who may have to work. I have thought a lot about what I would do if I had dependents (other than furry ones) and I truly don't know.

I work in a hospital in pediatric critical care.   When the disease hits our hospital, I plan to go to work and stay there until either I get sick and get over the disease or the first wave passes. My feild is kind of doc-intensive, and most of my peers have kids. If my partner, who an adult critical care physician, gets sick, then I'll probably rearrange my priorities.

My university is one of only a couple of institutions that offfers a masters degrees public health and disaster management. As such, we are (supposedly) at least 18 months ahead of other hospitals in planning. I think that means that we only are better able to recognize the deficiencies in our preparation. Our children's hospital has just spend about 150,000 to buy personal protective equipment (masks and gowns), extra oxygen delivery supplies, extra IVs, IV tubing and IV fluids, oral rehydration salts, and extra tamiflu and antibiotics and sedatives. Altogether we estimate that our extra supplies will last us about 2 weeks. We had to use 10,000 of our budget to pay to store this stuff. In that we haven't spent a penny on food, water, blankets for staff who stay to work.   Here's an example of the huge problems we encounter. Hand sanitizer is very flammable, so if you keep more than about 3 days supply for our hospital around, OSHA requires special hazardous materials storage which costs a fortune.

For those of you who are not in medicine, think how overwhelming it was to spend part of your tight budget to prepare for a famiy of 4-7. Then multiply by the 200 staff and their 500 patients what fill the hospital. I feel that it is nearly impossible for hospitals or clinics to be prepared.

I feel that my institution is trying to protect me, but I don't feel protected. even if we have enough masks and gowns, all it takes for us to expose ourselves is to touch our noses with a gloved hand, or use a telephone or a keyboard that an infected person just used. I have no delusions about how conscientious I will be able to be after working in a war zone for two weeks.

I don't have any advice except to talk as a couple about what you'd do. It might be helpful to talk about what you would do in different types of pandemic. In a mild pandemic, (say a death rate of < 1/2 % mostly impacting the elderly and those with comorbidities) the role that doctors and hospitals play in keeping communities together will be important. Your husband's risk would be lower in such a pandemic, because ( I assume) he's healthy.   If the disease is even half as nasty as it is currently in asia, there may not be much sense in doctors and nurses going to work at all. Using the numbers from the most recent publication on outcomes (Intensive Care Med. 2006 Jun;32(6):823-9), I roughly estimate that about 2 medical personell would die for each life saved in the ICU. Society will need doctors and nurses after this is all over. It stands to reason that society would be best served in the long run if medical people suffer a mortality rate that is not significantly higher than the general population. Otherwise, we'll be left short for a decade at least, untill new people can be trained to fill the positions of those who died.

I'm saying this to say that although I plan to go to work, I don't think it is unethical for doctors and nurses and repiratory therapists and so on to stay home to protect themselves and their families, particularly if the mortality rate is high. I think it is a decision that each person has to make for themselves. As a pediatrician, I think that if it's bad, those of us without children should work, and those with children should stay at home to protect the next generation. frankly, it's not doctors who will be most needed. Diagnostic skills don't matter much when everyone has the same disease. What we need is more nurses and respiratory therapists.

I truly don't believe that doctors or nurses will be forced to work. The military has the power to do this in every state (doctors can basically be conscripted into military service.) If it's bad enough for the military to think of doing this, they will have their hands full keeping order and distributing food. I know that our hospital has no plans to force anyone to work.

You could also talk to your husband about what would be his triggers for coming home to stay. Maybe he comes home when they run out of masks and gloves. Surely he comes home if one of you gets sick. It might make you feel better to know.

I wish I could help,

gardener

   I plan to work in the ER during a pandemic, but I long ago recognized my limits. The kids and significant others hopefully will all go to the ranch and sit it out. My wife will probably work from home and we can isolate from each other fairly easily due to the floor plan although she may also go to the ranch. I plan to work 12 hours a day 6 or 7 days a week. I have shown in studies of productivity of physicians in our ER that it falls dramatically after about 8 to 10 hours and 12 hours of going hard is about all most persons including myself can do. I worked very hard for 14 hours with practically no break during a flu epidemic once and the next day was still exhausted. I will need to leave the ER to recharge and plan to leave at the 12 hour mark no matter what for self preservation. I would not like to stay at or live at the hospital under the conditions I envision.  ER Doc

You guys are truly impressive.  I hope that your med centers are doing some planning ahead of time.  I know that some state governors are now planning on building makeshift outdoor triage units using tents in the event of a pandemic.  It seems like a good idea because the patients would be out of the hospital altogether.  Offsite / separate isolation seem like the wise approach. 

 

 

I'm a 48 yr old nurse with ICU/PCU/PACU/Home health experience-so I plan to work and isolate myself from my family if mortality and transmission rates are high. We have a farm about 1.5 hrs from where my son and daughter will be living (daughter  just starting out as a new graduate RN and  son will be a Junior in college)anyway-they can retreat easily to the farm with my husband intil the events pass over.

 

I hope my 22 yr old daughter escapes the pressure to work, since RNs will be in greater demand after the pandemic, but she says she's not afraid and wants to be of help.

I guess I'll start prepping now with additional supplies for medical support, fuel, food, etc. I've been just watching and "mentally" prepping-but feel that I have to begin accumulating stuff now.

Getting young adult kids ready for college & carreer is keeping me from spending $$$ earlier.

 

It's interesting to me that they both will be moving from 2 different small towns to the same large city close to our retreat.

God's providence in effect once again!

 

I really appreciate the MDs contributions-many of your posts are being forwarded to other professionals who are learning from your input. Great ideas for logistical planning being shared.

Keep up the good work!

MJ

I have been thinking about this thread since I read it yesterday. It is filled with a lot of heartfelt emotion and good will. I was trying to imagine a scenario that would protect doctors/staff and their families. Anharra has a great idea -- have doctors on call stay at designated motels near the hospital. Is it even possible that a Ronald McDonalds house ( or a similar home used for out of town family stay) be used for such a purpose? Is it  possible that something like a meals on wheels could provide nutritious meals for those on duty? I am just a layperson here, but I do care and hope some plans can be set to protect those that protect us.

your plan for addressing staff concerns to ensure that they will show up to work?  .........................................................................................................................

Thank you Terms...

Albert, What you are stating is very similar to our local county bird flu plan.  We will have triage, to see who is infected w bf. and tents etc. Just like you're explaining.  We are very lucky  to have an pro active public health director.  She is taking the upcoming pand very seriously and  she has already done trial runs w EMS, fire and local sheriffs dept. We were even lucky enough to have cooperation  from our surrounding counties.  They plan on mandatory shut downs of all airports, schools, and supermarkets, as well as any places where people congregate in mass.  Closing of supermarkets to soon is the only thing that might be a problem.  As soon as everyone realizes we are in trouble, there might l be looting similar to Katrina disaster.

    I'm sorry to say, but you aren't likely to make a lot of money this way. Since 911 disaster preparedness plans have been scrutinized by Joint commission or jcaho accross the country. It is mandatory that all hospitals have an "all hazard disaster plan" that addresses the need for decontanimation in case of terrorist attack using chemical or biological weapons. Because of this, hospitals already have large decon tents. Our university system is planning to use these tents for triage outside our ED's.

For off site alternative care centers, I doubt anyone will go to the trouble of buying a tent. We have precious little money to spend on such things, and the county has the authority to comandeer existing buildings.   the county health departments and governmental agencies are the ones coordinating out-of-hospital care sites, along with community physcians who have office practices.

Why buy a tent when your local high school is now closed to students but has a gymnasium with mats, multiple large rooms, a heating and cooling source, bathrooms, etc. Schools and athletic centers are the planned location of non-hospital triage and care in my city.

gardener

As a nurse with little ones at home I continue to be torn, I have  a plan to confine myself after working.  But I am really contimplating double checking my life insurance policy to see if there is some clause that would prevent my babies form collecting in the event i would die, and the insurance co. did'nt go bankrupt. The other point is that i do not have much family to take my kids if i did pass, this is a depressing thought but we have to be realistic, maybe talk to someone or have will and document s in order and given to a designated person, Again sorry for such sobering thoughts.  If  we healthcare persons are potentially continually exposed we need to think ahead for our kids and loved ones. My best to all. I think my kids are sore from all the hugs !!!!

Albert wrote: gardener, if you're in charge of the panflu planning for your center, you guys might be in trouble lol.   You have NO solid plan in place to handle the over flow, you talk about what schools "might" do, but that is poor planning.

    
Albert,

That was fairly insulting. There is nothing you could possibly tell me about how underprepared my hospital or the whole medical system is for this problem. I might go so far as to say, you have no idea how screwed we are going to be.   I might even go so far as to say you can't begin to understand the logistical and other difficulties involved in coming up with a coherent plan to take care of the number of patients we expect from a cachement area of 9 million people with precious little help from government agencies.

Here's something to scare you. My university, as one of few institutions offering a masters degree in disaster management, is considered so far ahead of other institutions in planning that OSHA called us 3 weeks ago to ask if we had a plan for offering voluntary quarantine at work and post-exposure quarantine to our staff. You think we're bad...you have no idea.

While you are sheltering in place, don't mock those of us who are walking into the storm.

gardener

I cannot speak for what is going on interpersonally here but we must not speak in ways that are reactionary.

There are so many ways that we can all say how bad this will be but that will only fuel panic and we are all trying very hard to stem that. Time to "suck it up". We are all walking into this storm! Clearly in different ways but walking on nonetheless. Some attempts to be of assistance may work better than others but there is no time to critique now, hopefully we will be able to later. Every effort needs to be encouraged.

Albert has made a very good point re: overflow of patients. Our town has already planned to triage within the town. Our local hospital is not equipped to handle a major auto accident so this is the best plan. The one ambulance in town and the EMS personal and first responders unable to handle the volume. Those families in need of respite care for a family member will have to bring their loved one to the ACC facility that will be in place. Site for mass graves spec'd and ready. We are standing on the beach and the tsunami is coming. Sometimes I feel paralyzed while I watch the waters recede.

We have to put aside or personal differences and work together.

I haven't seen a hospital simulation yet in which they implemented their preparedness plans.  This tent company would be willing to help run some simulations by setting up a 10,000 sq foot tent for a day, but the med staff would obviously have to move in the medical equipment, as well as running the scenario itself.  

gardener do you have a list of equipment that should be available for each tent based on a given population served?

Also an idea of what tasks that untrained community members can accomplish. When pressed there are many people who can push the learning curve. As people realize, very quickly, what we are up against they should be put to work.

There are many communities out there without a plan of action. Something written here may help those who have to begin a response at a grass roots level. We cannot give up.

If gardener has the time, maybe she could outline the equipment and number of staff that this sort of panflu scenario would require.  Maybe all of the area med centers could share one location, which would save everybody time and money.   Maybe do it by county? 

standingfirm and albert,

I'm sorry. I read a lot of posts taking pot shots at the medical community. I don't necessarily disagree with them.   We've certainly got our problems. Occaisionallly they push me over the edge.

I don't disagree with Albert's global assesment of the inadequacy of planning. On this forum, I'm often trying to say no, it's probably not AF--yet.   At the hospital, I'm the alarmist. My peers refer to me as the horseman of the apocalypse.

I know it seems like authorities are doing nothing, but it's just harder than you think.   Even if everyone involved is convinced of the urgency of the need, it is just damn near impossible to multiply our medical system --even a shadowly diluted version of it--by a factor of 10.   It is possible the the inadequacy of our preparations is at least in part due to the grave and vast nature of the problem, not just because we are losers.

As one who is trying to wake the system up to a problem I believe is real, Albert's comment about what a crappy job I'm doing makes me want to say "Oh yeah? You got this all figured out?!" plus a bunch of things I can't print here.

gardener
    

standingfirm wrote: I would have something set up in my own yard that would enable people to receive rudimentary care and comfort in their own neighborhood!

To the best of my understanding, this is close to what is actually going to happen. You could argue that haveing triage and lower level care centers near hospitals makes sense. What has been argued is that it makes sense to have them closer to the people who need them, in neighborhood schools. If you want to voolunteer, I'm sure there will be opportunities.

I know people have said it makes the most sense to stay away from care centers, since they will have very little to offer, but imagine a family where the parents are sick and can't take care of their fkids. They will need the help of community centers just to bring them food and water and keep the rugrats out of trouble.

gardener
    

I understand gardener. Anyone with a true awareness of the scope of this is overwhelmed. I am and I have a rudimentary awareness.

We are all going to have our times of taking pot shots...it is hard not to vent these frustrations at the nearest person who will listen especially when your heart is to serve the best you can and you know that it won't ever be enough.