Tracking the next pandemic: Avian Flu Talk |
Albert’s medical tents |
Post Reply | Page 12> |
Author | |
Guests
Guest Group |
Post Options
Thanks(0)
Posted: August 24 2006 at 4:39am |
In another thread, Albert sparked a discussion of medical triage or care centers distinct from hospitals. I thought it might be nice to continue discussion of these centers with a fresh focussed thread.
Albert wrote [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. ]
I can do this, if you like. I need to know what is your vision for these centers. Would they
a) provide a surrogate for family care when family members are unable or unavailable to care for loved ones?
b) provide low level care such as IV fluids and oxygen, +/- basic antibiotics
c) serve as triage areas to decide between sending patients home ( with education) keeping patients in a regional non-hospital center, versus sending them the to hospital ED.
d) all of the above
e) some other idea
I would also need an estimate of what size community you would be planning to provide for.
gardener
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Gardener,
I have some hospital administrator contacts in my area, if and when you all decide this is a go. Argyll.
|
|
Scotty
Adviser Group Joined: March 06 2006 Location: United Kingdom Status: Offline Points: 846 |
Post Options
Thanks(0)
|
Aircraft Hangers.
Ambulances at the front, Refrigeration trucks at the back. Perimeter fence. Armed guards. Efficient data collection. Efficient disposal process. Survival rate? Slightly less than if you had stayed at home and taken your chances. |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Scotty, my dear, you may be right, but the idea from the other thread was a community center where volunteers would care for people who are already infected and too sick to care for themselves, but perhaps not sick enough to land a spot in a hospital. I think that's what they meant, anyway. They may have been talking about providing such places as hospital exteneders. I'm not sure--I'm waiting for a response from the people who were interested in talking about this. Doctors, nurses and those bearing the red cross have long enjoyed safe passage through dangerous areas. If armed guards and a perimeter fence are necessary for a place of the sick with few resources beyond neighborliness and altruism, there's not much point in talking about it. Please, let us live in this little dream world where people actually care about each other's welfare for a while.
gardener
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Gardener. What search words would you use on the net to find a place to buy IV drip equipment and fluids to put into them. I undersatnd oxygen would not be available to the lay populationin a pandemic because the canisters are explosion hazards and therefore not readily available. I should like to be in a better position to care for sick loved ones. I'm in the UK so US suppliers probably wouldn't ship to us.
Beth
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
You need a script for this stuff, unless it is labeled for veterinary use.
I just tried. I froogled for normal saline and 0.9% saline and found nothing. If you look for lactated ringers you'll get IV fluid bags, if that's the fluid you want. I froogled "IV veterinary" to find IV tubing sets, and IV catheter" to get the needle sets.
If you find a source for liter bags of normal saline, let me know.
gardener
p.s. I lied. I just looked more closely at the website. You even need a script for veterinary use.
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Thank you Gardener. Just the tubes and needles would be a start. I could think about the fluid bags later. But would the fluids be the same for vet use ie suitable for humans?
Beth
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
yeah.
gardener
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Hi gardener,
What i was envisioning is less of a medical center and more of a visual reminder that there is a system in place. gardener: Mostly A and C in my regional and local system that is in place already. A place for communication and support so that people can care for their loved ones and neighbors at home. It would have to work within the system in place and not be an attempt to duplicate. More of a visual reminder that there is help available. Of course, in areas that are not ready these neighborhood centers could be much different. I can only answer based on the readiness of our region and town. There are already plans in place that should not be duplicated. Neighbors helping neighbors. Providing direction, support, MREs, water, security, and advice about caring for family members. Also, and probably most importantly, these would serve as a visual support. Communication is crucial - neighborhood centers would allow us to know what is going on in our small areas. If I know my neighbors entire family is ill and at home I can bring food and water support to their door. I can also report back to local public health what the need is in my small area. If medical care is needed beyond what the family can do I can encourage and support the decision to move further down the line in the system. Neighborhood centers can be the way to get people that have recovered back into the system as caregivers for others. It is less intimidating to help those you know in a small center. I will pray about more ideas. |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
standingfirm,
Visual reminders, communications you have tapped a crucial area. I bet you could come up with a great visual concept - you certainly are thinking along the right lines. Neighborhood, community triage -- educational center. Gardener can bring the medical know how to this whole idea to make it happen.
Note: Gardener -- in rereading your post I think D all of the above is spot on ...
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
I know this may not be a triage solution, but I read somewhere that hotels may be taken over and used as hospitals solely for flu patients.
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Albert, I would volunteer my property for a small unit. Under Good Samaritan Statutes I would be covered and there would be less red tape.
http://medi-smart.com/gslaw.htm I have a small lot but I could sooner convince my neighbor (1 acre) than involve my local government. I have only 1/3 of an acre. Most people would be walk-ins anyway. |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Here is an idea I came up with a while back and certaintly this is not a copy but just an idea that might inspire someone to come up with a better copy. This could be printable and I would include at the bottom a blank area for a local neighborhood triage facility to be listed. It would be basically designed to educate and give directions to outside help should someone need it.
Preparing for Avian Influenza -- Seven Simple Steps.
1. Store enough food and water for 3 months. Include one gallon water per person each day. Remember to include your pets.
2. Stockpile all necessary prescriptions drugs.
3. Prepare an emergency kit for your family. Include any medical items that you might need at home.
4. Collect and make copies of all important documents -- including medical records. Store these in a waterproof container.
5. Store gas in an approved gas container for possible use in a generator.
6. Create a family emergency plan and keep in a special folder. Add additional information that you might find helpful. First Aid Book, Survivial Book, etc.
7. Visit the pandemicflu.gov web site for additional information. This federal pandemic flu web site has information to help prepare your family.
Should your family need additional medical help visit your local neighborhood triage located at:
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
I have a wonderful local legislator who knows my heart (a little bit) from previous emails. edited for internet safety reasons
I would need back up lest she thinks I am just a kook with a plan and no way to carry it out (alone I cannot). ---------------------------------------------------------- Avian Flu Forum - Neighborhood Response Unit |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Gardener,
In regards to the IV fluids/bags/tubing, not sure if this will help, BUT, try sciplus.com.
I bought a couple sets of oxygen masks/tubing (set comes child and adult masks) and are meant to be used with oxygen bottle, or nebulizer (needs an adaptor for the oxy bottle). Anyways, paid $.99 per set at sciplus. They have a lot of oddball stuff there, and sometimes it's worth a look.
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Beth-
Oxygen tanks are readily available here, on prescription, for medical use by non-medical persons. They are not dangerous with simple handling precautions: (1) NO SMOKING in the area where they are used (2) Reducing valve should be attached by a professional (usually at the tank rental location). Folks have them at home, and there are small ones for portable (car, wheelchair) use. |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Gardener et al, This is positive talk. However, the tent thing has me at a loss. If it is a pre-hospitalization decontamination tent that is one thing but if you're talking about triage of H5 infected and non-infected, I would think an existing structure with facilities such as schools/churches/sports arenas, etc. can be fitted to hold symtomatic patients (no ventalators of course), but comfortable areo-beds, O2, IV's, plumbing and electricity. These MASH units can easily be prepped and stored until needed. This will save time and confusion when a wave is approching. Too many local emergency officials are still stuck on the Magic Bullet plan of storing only anti-virals and good intentions. If you think issue needs attention, please call your city manager today and ask what plans they have in place. |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
exhausting isn't it?
I can see why people shrink back and say we are on our own...its like shoveling against the tide! I understand gardeners rant a little bit more now. I guess our efforts have to be measured or we will burn out. |
|
Scotty
Adviser Group Joined: March 06 2006 Location: United Kingdom Status: Offline Points: 846 |
Post Options
Thanks(0)
|
Beth: I'm not a chemist but if I remember my school chemistry correctly I believe oxygen is relatively easy to produce and its really the storage problem that needs to be solved. Running an small electric current through water should do it. I think the correct catalyst is platinum. Expensive but not difficult to find.
This is one of those don't try this at home warnings. The two gases given off are hydrogen and oxygen. In small quantities the burn nicely and recombine into water. Both gases are extremely dangerous in larger quantities and should not be stored. |
|
Scotty
Adviser Group Joined: March 06 2006 Location: United Kingdom Status: Offline Points: 846 |
Post Options
Thanks(0)
|
P.S. Surely welders use oxygen? Do they need a prescription?
|
|
Scotty
Adviser Group Joined: March 06 2006 Location: United Kingdom Status: Offline Points: 846 |
Post Options
Thanks(0)
|
Any religion that can't wait two weeks isn't worth having. (Mayor Ole Hanson, Seattle, 1918)
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Good point about the churches Albert, The CDC has a planning guide for "Faith Based Facilities" the churches will be at capacity with their members. I hope the hospitals Pandemic Planning will include making agreements with other large facilities to create MASH units. The moving companies are a good point, I didn't think about moving all the stuff !!?! |
|
Dlugose
Valued Member Joined: July 28 2006 Location: Colorado Status: Offline Points: 277 |
Post Options
Thanks(0)
|
I don't know why you are presuming that the local hospitals are not already making these plans. They are in most hospitals in eastern Massachusetts. In the county in which I work, which is many miles from Boston, the local hospital would set up a influenza unit in a place, most likely a college gym that has been identified, and that would be the only place where someone with respiratory symptoms could go for triage. It would be staffed by a few from the hospital and volunteers mostly under the Medical Reserve Corps, which anyone in the public can join. If someone set up some private tent for this purpose, unless the public place was already full, most likely it would be ordered shut down as a public health hazard operating under overly risky conditions, and the patients sent to the public shelter. You can find out what the local plan is through either the persons at the hospital in charge of pandemic planning, or local or county health officials, or the local Medical Reserve Corps, or possibly the Chief of Police. Your ideas are great but may be a duplication of effort.
|
|
Dlugose RN AAS BA BS Cert. Biotechnology. Respiratory nurse
June 2013: public health nurse volunteer, Asia |
|
Jhetta
Valued Member Joined: March 28 2006 Status: Offline Points: 1272 |
Post Options
Thanks(0)
|
Dlugose,
San Diego has outlined its hospital surge capacity plan and Hepa Filtered Negative Pressure Isolation in it's Influenza Response Plan.
Isolation requitements are outlined starting on page 138. Correct me if I am wrong... doesent the CDC require managing known and suspected cases of both SARS and avian influenza using Negative Pressure Isolation? Gardner... are there guidelines in place that outline when this procedure would be abandoned?
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
from jhetta
"...both SARS and avian influenza using Negative Pressure Isolation ?"
..............................................................................................................
Yes, that would be ideal. Everyone buy a window fan.
............................................................................................
from gardenr,
"...where volunteers would care for people who are already infected and too sick to care for themselves, but perhaps not sick enough to land a spot in a hospital...."
...................................................................................................
In 1918 they could not get or keep volunteers.
It would all (tent Hosps?)have to be set up ahead of time...what are the chances?
I think they should have in home IV use training. Flu kits in the mail.
|
|
Dlugose
Valued Member Joined: July 28 2006 Location: Colorado Status: Offline Points: 277 |
Post Options
Thanks(0)
|
Good point. The CDC rarely is in a position to mandate anything, but their recommendations are treated as needing good justification to go against. The medical community and state legislatures are now looking at the legal standing of procedures that get set upduring an emergency, allowing a lower standard of care during a pandemic without recourse to being sued afterwards. Even without legal changes, it would be impossible to set up negative pressure rooms for all flu patients, after the first few are already in the hospital. Those rooms are in short supply like ventilators. Some hospitals are planning the next best thing, rooms with diminished air exchange to other parts of the hospital. When these recommendations would be abandoned would be a local matter based on need, but in general when there are a lot of flu patients, most will be in a seperate facility such as a school gym converted to hospital ward, and the hospital will care for only the number of intensive care cases they can manage.
|
|
Dlugose RN AAS BA BS Cert. Biotechnology. Respiratory nurse
June 2013: public health nurse volunteer, Asia |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
I want to put some tiype of scale to this probblem, in case you all haven't had a chance to think about this on a population basis.
Imagine a treatment center for 100 patients, none of whom require anything beyond IV fluids and oxygen. Imagine an average stay of 1 week.
For those patients you would need 2 liters per day per patient of IV fluids. (I'm going to pretend they are on IV's all week, because many of them will be really dehydrated when they show up and will need more at first.) Probably something like a third would require oxygen. You'd need at the very least 3 IV's per patient, and 3 IV tubing sets per patient. (we normally change tubing every 12 hours)
Say the 1/3rd of patients would need oxygen, but only at modest flow and only for 4 days each. (This is a way underestimate) At 2 liters/minute flow, the large O2 tanks will last 52 hours, say 2 days average. So 30 patients use 2 tanks each per week.
Per treatment area holding 100 patients, you'd need 1400 bags of fluids, 300 Iv's, 300 sets of IV tubing, 30 nasal cannulas, 60 large tanks of oxygen per week. Staffing ratios planned in my city for off-site facilities, presupposing less sick patients and community volunteers, of course, reccommend at least 1 nurse per 20 patients (any nurse reading this is feeling nauseated about now, since normal hospital staffing ratios are 1 nurse to 4-7 patients) 1 respiratory therapist per 50 patients, and 1 doctor per 75 patients. A nurse could supervise 3 volunteers. Assuming each can work a 12 hour shift 7 days in a row, you'd need 30 volunteers, 10 nurses, 4 respiratory therapists and 3 docs per week.
Personal protective equipment fo 30 volunteers, 10 nurses, 4 RT's and 3 docs, changed only every 12 hours, equals 47 masks and gowns and pairs of gloves per day, or 329 per week. Hand sanitizer, say, 2 bottles per medical staff or volunteer person per week. That's 94 bottles per week.
Then you'd need food and water for at least 1/2 of the patients who'd be able to eat, and probably at least 1 meal per 12 hour shift for the volunteers and medical personell: that's 244 meals per day.
You'll need to consider that supply delivery might be a problem, so you should stock at least 3 weeks of materials in advance. Plus water, linens, towels, cleaners, body bags. I don't have time to calculate the cost of all this. I would love it if someone could.
I considered only the cheapest possible bare-bones interventions. I didn't include expensive things like antibiotics and narcotics for the dying, nor supplies to stabilize someone who is really sick before sending them to the hospital.
Now think about the scale of a small city.
If someone wants my calculcations, I will give them, but lets just say that for a pandemic with a mortality of 2.5 % and an atack rate of 10 % per wave, you'd need to be able to, during the middle 2 weeks of each wave, care for 500 patients per 100.000 population requiring hospitalization for flu alone. The average number of hospital beds per 100,000 in the US is 280. These beds are currently filled at 90-95% capacity, obviously now with non-flu patients.
Say that 30 % of the patients currently occupying beds can be kicked out, and everyone doubled to 2 per room, (despite a 40% reduction in staff.) per 10,000 population, you'd have 364 flu patients in the hospital, leaving 236 patients to care for during that middle 2 week period in your tents. Two such treatment centers, in addition to an amazingly well prepared hospital. For a city of 500,000, you need to care for 1180, or 12 treatment centers. For the Pheonix-mesa area, with 3.4 million you’d need to care for 8024. Is this giving you a headache yet? If you plan to keep flu ptients out of the hospital entirely, then you'd need treatment centers like this for 17,000 patients in Pheonix. This of course, would be impossible, because patients can be infected and shedding virus for 1-2 days before showing symptoms. At the height of the wave, at the very least 10 % of patients admitted for all causes would be positive for flu. At some point it will become impossibel to separate them. If the pandemic is worse than the one I outlined above, obviously these numbers could be much worse.
You wouldn't waste money on tents that would be cold in the winter, hot in the summer, and dependent on maintance by a company whose workers are sick, just like everyone else. You'd close down schools, take over churches (yes, churches--social distancing ordinances will limit non-essential congregation anyway) and BEG for volunteers.
Perhaps reading this you can get a glimpse of the problems that we are dealing with. This scenario I have written about details providing care for only the most basic and mild of flu patients. Imagine the ICUs. Currently, 68% of patients whose infections have been recognized by WHO have required ICU care.
pray that this will be mild and slowly evolving.
gardener
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
On negative pressure.
Forget it. SARS was airborne, but flu is droplet borne. You don't need negative pressure, just mask, gown and glove, used religiously. CDC does say that, but it isn't going to happen, and it isn't technically necessary. Besides, as dlugose said, each hospital has only a few negative pressure rooms, adn if you activated all of them rooms at once, you wouldn't be able to maintain pressure in anyof them.
gardner
|
|
Jhetta
Valued Member Joined: March 28 2006 Status: Offline Points: 1272 |
Post Options
Thanks(0)
|
Dan,
I was think more along the lines of TNPI
Fortunately from what I understand for hospitals with tight budgets, regulations don’t require permanent AII rooms for surge capacity; they allow for alternative temporary solutions, sometimes referred to as Temporary Negative Pressure Isolation (TNPI). A much less expensive, easier-to-maintain, and flexible alternative. TNPI can take on many forms, ranging from individual patient solutions to larger outdoor structures designed for surge capacity situations.
Question Dan: Is it your understnding that while organizations such as the CDC provide general guidelines for establishing negative pressure isolation, it’s up to the facility to determine the best solution for their needs and to incorporate the solution into an overall preparedness plan?
|
|
Dlugose
Valued Member Joined: July 28 2006 Location: Colorado Status: Offline Points: 277 |
Post Options
Thanks(0)
|
I think some homes or neighborhoods might have a few people staying together when they start feeling ill. People who start getting sick might not be sure it is the pandemic flu the first day. If you go to a flu ward with some other flu you will then have both flus, so best to stay home till you know you are sicker than usual. Meanwhile some sick people could take turns heating up some soup, fetchint the water, perhaps washing some clothes. There is no reason to start an IV no matter how sick you feel until you can't take anything by mouth. An IV adds dangers of infection of its own, and makes you harder to care for. When you need an IV you should be in a shelter unless there is a nurse or doc in your neighborhood willing to look in on you. I don't blame you for wanting to stock something, as you never know if someone will be able to take care of you. An IV drug addict could help you get a needle into your vein, but their technique might also give you an infection.
|
|
Dlugose RN AAS BA BS Cert. Biotechnology. Respiratory nurse
June 2013: public health nurse volunteer, Asia |
|
Dlugose
Valued Member Joined: July 28 2006 Location: Colorado Status: Offline Points: 277 |
Post Options
Thanks(0)
|
http://www.mhalink.org/public/Disaster/advisories/2006/prep-2006-09-2.pdf The Commonwealth of Massachusetts Pandemic Planning/ Hospital Influenza Specialty Care Units Massachusetts is actively preparing to respond to pandemic influenza. While we cannot It is projected that a pandemic flu will result in 2 million ill in Massachusetts alone, one
half of which are expected to require some level of clinical care including 80,000 hospitalizations state-wide during the first wave of the pandemic. An Influenza Specialty Care Unit will need to be available to each hospital to provide for the screening of outpatients, and for the care of flu patients that do not meet the criteria for hospital admission, but who are too sick to be cared for at home. We are continuing to move forward with our planning for local Influenza Specialty Care Units. While we do not have all the questions answered yet, we are working hard to complete a full template plan for your use. In the meantime, there are three steps the hospitals are expected to complete. · Step 1: At this time, all hospitals should be working to identify those communities in their area that will send flu patients to their Influenza Specialty Care Unit. The communities should be divided up in proportion to the capacity of the individual hospitals. Please work with the other hospitals in your area (whether in your region or not) to designate the appropriate alternate care sites to which residents of specific communities will be directed. · Step 2: Once the communities have been designated, the hospitals should contact
the Health Directors of those communities to decide in which community it makes the most sense to locate the Influenza Specialty Care Unit. Once the specific community is chosen, the hospital should work with the Health Director of that community and begin a dialogue of possible sites to consider. A set of guidelines have already been distributed to hospitals. Hospitals may also want to look at buildings in more than one community. If that is the case, a prioritized list should be developed and work should be done in collaboration with the local health officials in each community. It is important to determine if the selected building has been pre-designated for another response function, such as an Emergency Dispensing Site, or shelter. In that event, representatives from the hospital, the health department, and the community emergency manger will need to work together to determine if the selection of the ISCU site is feasible. · Step 3: Once a site has been selected, the hospital should notify your regional hospital coordinator to schedule a site visit. All sites should be identified by June 30, 2006. Visits will be scheduled as time permits. · Step 4: Submit ISCU license application to MDPH. |
|
Dlugose RN AAS BA BS Cert. Biotechnology. Respiratory nurse
June 2013: public health nurse volunteer, Asia |
|
Hotair
Valued Member Joined: March 17 2006 Location: United States Status: Offline Points: 667 |
Post Options
Thanks(0)
|
Beth and gardener, I googled I.V. fluids and found a place a while back that would sell Lactated ringers or normal 0.9% saline by the case. I really don't feel I need that. I do think I would buy a case of blue pads,though.(These can be placed under the patient and the fluids won't go through onto the sheet). I am trying to work up the nerve to ask my Vet. I know what her reaction will be but I know how to place catheters,etc. and have done it for years(Vet.tech).Admittedly, I haven't done any on humans before but hey, humans don't have fur coats to fight...If push came to shove, I would at least like to be prepared.
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
A tent for 8000 sick people?? what is it with the tent thing? There's no way you could keep order, keep supplies moving, keep track of patients, keep staff from going postal. 3 million liters of fluid per week, 4,800 large oxygen tanks/ week, PPE for 400 staff, food for 20,000 meals a day? Are you gonna have running water in those tents?
You have to think small and local. The more centralized this is, the easier it is for structure to break down. Smaller community-oriented treatment centers in existing buildings are the way to do this if it is to be done. I didn't just make this up. That's what cities and counties and hospitals all over the country are currently planning.
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
As I read through every post on this thread I thought about something: most of these interventions address providing services during an AI outbreak. They will be much needed and very important.
The situation would be so massive during an AI outbreak that any efforts we put to reach the masses before AI strikes could really be maximized. I do think each of these ideas you have presented is worthwhile. Now I understand why the higher ups have spent so much time and energy on preparations beforehand. AI has the potential to change the landscape of our communities. To each of you -- your passion on this issue is admirable. It is an honor to be part of such a caring community. Argyll.
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Gardener: ...and even smaller bites to take the pressure off the medical system even further by having even smaller units reassuring and supporting the walking wounded who are just afraid and overwhelmed.
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Albert,
The funeral homes will be overwhelmed early on. There won't be enough body bags. The Downtown Burial Mound may become a fixture.
To go along with gardeners calculations: consider 30% develop avian flu symptoms. Now look at the 3 patient type categories for flu (below) the amount of supportive medication, IV fluids, O2 and basic bedside supplies will require warehouses full of supplies. Has anyone heard of any facilities prepping on the warehouse level?
Type 1 patients - have the poorest prognosis and almost all will die within 2 or 3 days of the development of their first symptoms. The cause of death in these patients during the 1918 flu was massive respiratory failure from overwhelming lung-destroying viral pneumonia. There was no effective treatment for this in 1918, and there is non today despite all the advances in medicine that have occured over the last 90 years. Signs and symptoms of type 1 patients include rapid onset of severe shortness of breath, cyanosis (bluish discoloration of the skin around the mouth, hands and feet, and/or bleeding from the lungs, stomach and rectum. These patients may also experience changes in their mental status up to psychosis and suicide attempt.
Type 2 patients - are similar to type 1 patients except they do not die after 3 days. Some but not many of these patients would survive if they had access to an ICU, ventalators and expert medical care but if we have a severe pandemic, thoses resources will not be widely available. Even if they had access to these services, many of them would die anyway. These patients will likely develop at least 2 secondary viral and/or bacterial infections. These patients may also develop changes in their mental status up to psychosis and suicide attempt. Remember, no matter what you do, they are likely to pass away in a week to 10 days after becoming ill.
Type 3 patients - make up the majority of those who become ill with influenza. Fortunately, these patients have a good prognosis if they receive timely and diligent supportive care that can be provided in a non-medical setting such as the home or improvised hospital. Most of these pandemic flu victims will be severely ill and weakened by the infection such that they will be too ill to get out of bed. Many type 3 patients will be completely dependent on others for care. Without simple care, some of these patients will die from preventable causes like dehydration but with simple care, most of these patients will recover. No matter how good the care provided, some type 3 patients will die. This is not your fault. This happens usually because they develop a serious secondary condition that actually becomes the cause of death. Examples of these secondary conditions include bacterial pneumonia, stroke and heart attack. These patients may suffer extreme changes in their mental condition including panic, severe grief of loss of family members, depression and suicide attempt. |
|
Frisky
Valued Member Joined: March 14 2006 Location: United States Status: Offline Points: 123 |
Post Options
Thanks(0)
|
The adult hospital where I work and the pediatric
hospital across the street are preparing a joint effort to handle a
pandemic. With no preplanning or offsite medical capabilities we
estimate a peak of 5000 patients a day would show up. We can not handle
that many patients. We run about 500 per day now. This has led to a
concept of breaking patients into manageable packets. One of these
packets is a high school. A joint security perimeter will
be set up and will include a high school conveniently located
across the street. The plan for the high school is to house entire
family units.We have found with previous flu epidemics that the entire
household often gets sick within a several day period and the plan will
be to care for the entire family at the high school . Logistical issues
are actually even worse than mentioned by gardener. They include
feeding, bathroom useage and associated issues such as toilet paper,
bedding,and janitorial issues. We can overcome a lot of these issues by
requiring family participaton such as bringing your own bedding and
towels. This can be managed by public service announcements, paramedics
bringing all of these items when they pick up patients, or volunteers
who go to the home and bring the items. The issue of dehydration
management will have to consist primarily of use of the oral
rehydration formulas developed by WHO for third world medical
management because there will be too many patients and not enough
resources to manage with IV rehydration therapy. We need a lot of
phenergan and hydroxyzine. We also need a comprehensive list of what
patients are to bring because to a large degree even in a care facility
environment a lot of the major logistical issues can be solved by the
patients themselves. Volunteers, nurses, techs, and physicians will be
managing these patients as a team and no one will be allowed to work
longer than 12 hours before they are required to leave. Really sick
patients will be sent to the hospital but the definition of really sick
may be a moving definition. The public health dept director and our
pandemic planning committee are working on other "manageable" packets.
ER Doc
|
|
It is better to give than to receive.
|
|
Jhetta
Valued Member Joined: March 28 2006 Status: Offline Points: 1272 |
Post Options
Thanks(0)
|
Great post Frisky!
|
|
Dlugose
Valued Member Joined: July 28 2006 Location: Colorado Status: Offline Points: 277 |
Post Options
Thanks(0)
|
I don't understand Albert, when you google just government sites, with
" morgue pandemic planning influenza site:.gov " you get:
Results 1 - 10 of about 174 for morgue pandemic planning influenza site:.gov
That is certainly a start. Advisors in each region are on
Disaster Mortuary Operational Response Teams http://www.dhhs.gov/emergency/mediaguide/PDF/02.pdf
Ten regional teams formed to provide help to local officials intasks relating to the recovery, identification, and burial ofvictims. One national team is specially trained to handle eventsinvolving Weapons of Mass Destruction. Members are private citizens with specialized expertise. Examples of types of team members include: funeral directors,medical examiners, coroners, and pathologists. Include two Disaster Portable Morgue Units, which arecomplete morgues that can be deployed to an affected site |
|
Dlugose RN AAS BA BS Cert. Biotechnology. Respiratory nurse
June 2013: public health nurse volunteer, Asia |
|
Frisky
Valued Member Joined: March 14 2006 Location: United States Status: Offline Points: 123 |
Post Options
Thanks(0)
|
In our case the county public health director is really onboard.
He is working on the facilities which otherwise would not plan and has
already met with personnel from all 10 hospitals in the county
regarding pandemic and general disaster planning. He already has
700 volunteers signed up and eventually is trying to get this
number up to 5000. He has met with the county medical examiners office
regarding mass casualty body management and they have stated they are
ready, but I do not know the details. I am in Texas which is a green
state in regards to disaster preparation. This probably has a lot to do
with the learning curve provided by Katrina and Rita and the floods in
Houston a few years ago. We still have a long way to go.
ER Doc
|
|
It is better to give than to receive.
|
|
Guests
Guest Group |
Post Options
Thanks(0)
|
The basic premise behind the neighborhood centers is not that they would provide a major amount of care but that the more people you can recruit into taking ownership of the problem the less they are likely to overwhelm the system. That is the major mistake that I see happening in the government response to date.
A volunteer public health corps modeled on the civil defense corps is ideal. People are more likely to be involved if it means taking responsibility for those near and dear to them. The more people you can educate ahead of the event the fewer people you will have clogging the system out of sheer terror. Public health corps workers can be plugged in anywhere into the system based on ability and willingness. Those serving, get priority for treatment. |
|
Albert
Admin Joined: April 24 2006 Status: Offline Points: 47746 |
Post Options
Thanks(0)
|
I suppose the problem is solved. It seems like we're much more prepared than what I thought. |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
No way are we prepare because the people aren't prepared and they will be the downfall of every plan put in place. The government is afraid of panic so they are not educating the masses. Huge mistake! People who know what to expect will not panic. There may not be the amount of panic but there sure will be emotionally, physically and even intellectually overwhelmed people. There will be panic and a whole lot of violence when people run out of the basics for survival. Then what?
There should be community service messages every day and that is not happening. We may have already had an initial outbreak event in the US and not even know it. Would it surprise any of us if this started tomorrow? Not me. Not that I think it is going to, i am just saying that it wouldn't surprise me at all. Not one of my neighbors is ready and I have been talking about preparedness for months now to at least 10 different families plus the employees in my husbands store. If the government and their own physicians won't acknowledge this why should they believe me? |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Great post, Standingfirm. Albert, Is it possible we can take this formidable forum to a "make it happen now" level?. Can we move now to -- Pre-Pandemic and educate? Paper America now with steps to prepare and protect? Move to quarantine when the time comes? And, have the medical triage response teams in place when AI strikes. For me it is black and white: everything is measured in terms of Pre-Pandemic -- Post-Pandemic. |
|
Guests
Guest Group |
Post Options
Thanks(0)
|
Thanks for your post, frisky,
You summarized where things are better that I could. I feel like we are both more and less on top of this than most people think. I know that didn't make any sense, but perhaps you know what I mean. more on top of it in htat we have probed, in exhaustive detail, the limitations of our system, and less in that we haven't come up wth ways to overcome it all. It sounds like your plan for alternate care sites is ahead of other cities, and ahead of us. I haven't heard that we have a list of volunteers, for instance, and I don't think we have supplies of ORS. We but then we haven't had a joint hospital and community planning meeting in a while. We are still concerned about our supplier's ability to maintain food and O2 deliveries, to say nothing of meds. I'm sure you all can see that it's hard, because in planning for medical care you are dependent on the timely function of so many other businesses. garderner |
|
Post Reply | Page 12> |
Tweet
|
Forum Jump | Forum Permissions You cannot post new topics in this forum You cannot reply to topics in this forum You cannot delete your posts in this forum You cannot edit your posts in this forum You cannot create polls in this forum You can vote in polls in this forum |