Albert’s medical tents

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.   

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.

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.

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

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.

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. 

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.

 

 

Gardener,

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.

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.

Any religion that can't wait two weeks isn't worth having. (Mayor Ole Hanson, Seattle, 1918)

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.

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. 

Dan,

http://www.mhalink.org/public/Disaster/advisories/2006/prep-2006-09-2.pdf The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
250 Washington Street, Boston, MA 02108-4619
MITT ROMNEY
GOVERNOR
KERRY HEALEY
LIEUTENANT GOVERNOR
TIMOTHY R. MURPHY
SECRETARY
PAUL J. COTE, JR.
COMMISSIONER
June 12, 2006

Pandemic Planning/ Hospital Influenza Specialty Care Units

Massachusetts is actively preparing to respond to pandemic influenza. While we cannot
know when a novel virus will emerge that is capable of effective human-to-human
transmission, most experts agree that an influenza pandemic is inevitable. The unique
challenges of pandemic influenza and the potential for widespread illness require us to
build on and strengthen our existing preparedness plans and initiatives so that we will be
able to meet the needs when a pandemic does occur. The National Pandemic Plan,
supplement 3, specifically addresses hospital facility preparedness. While the World
Health Organization and the CDC are keeping a close watch on the activity of the H5N1
avian virus, this virus is not capable of effective human to human transmission at this
time. Meanwhile, we are preparing for an inevitable pandemic, whether it may be a shift
in the currently circulating avian virus or another yet to emerge.

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.

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.

    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

Albert wrote: For this plan, the county coroner should be stocking up  on body bags to handle all of the corpses (possibly 8000 in Phoenix) since there will be no way to realistically treat them.   ...  Quite frankly, nobody has even taken a baby step in the right direction yet.

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.

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?

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