What should healthcare workers do?

My hospital hasn't fitted us with n95 masks and I work in surgery! I do not think the United States is taking this seriously at all. They are not making it manditory for hospitals to be doing this. They wahnt us to show up for work and do whyat we promised. They need to keep us safe in the process!

I wonder how many hospitals and clinics actually have trained staff members and equipment so they are capable to do fit testing?  If you live in a rural area, I think the numbers of these trained people would be low.  You are not supposed to do fit testing unless you are certified in the procedure. 

 Keegs2:  Each person using the duckbill-type mask for protection from airborne diseases is supposed to be fit-tested using an OSHA-approved method.  We use the the qualitative method with a hood and a bitter or sweet solution the person tastes.  Large facilities usually use a more advanced quantitative method.

If and when a pandemic hits,
I would no sooner think of going to a clinic or hospital emergency room, than I would  visit a nuclear power plant during a meltdown or a warzone after a chemical attack....
In other words, I wouldn't blame anyone for wanting to stay home and take care of the family as well as staying isolated from others as much as possible. That is assuming that the H to H strain of the virus becomes airborne and is just as deadly. The only way I would want to treat patients is if I had my own Hazmet suit and worked in a germ free environment like the facility in the movie Andromeda Strain. But who am I kidding, I think my real behavior would depend on the circumstances and reality of the moment, and I would hope that deep inside I would have the moral guts to make sacrifices if it meant saving someone's life. And I'm not a doctor or nurse but I work in a medical lab. And we'd better all hope that the scientists who will be needed to develop the needed vaccines after THSHF will continue to go to work, please-thank you very much !

Sniffles- She has said she would cut her license in half and tell them to keep it.  My advice to her is fake a psycotic episode or what ever she needs to do to be there for them.  I don't intend on leaving orphans behind to fend for themselves.  In John Barry's book "Influenza" he addressed the subject of the unknown amount of single family households after the 1918 pandemic and the unknown amount of orphans due to the death of BOTH parents.

Tue Mar 21, 5:51 PM ET


Experts struggle with issue of what medical masks to stockpile for a pandemic

ATLANTA (CP) - The issue of medical masks - who should use them, and what types should be stockpiled - is one of the vexing and potentially explosive questions facing public health experts working to prepare for a possible flu pandemic.

With precious little science to go on and in the face of the strong probability of a global mask shortage, they are struggling to craft recommendations that strike the best balance between the ideal and the feasible - without a clear picture of what either will be when the next pandemic hits.

Speaking on the wings of an international conference on emerging infectious diseases, experts readily acknowledge a global wave of illness could place modern day standards of infection control out of reach.

"If this thing rages for a year, all of this is academic, all of these stockpiles. Because we're going to burn through all of that. So we have to have plans," said Stewart Simonson, assistant secretary of the U.S. Department of Health.

"Health care may end up looking, for a little while . . . more like the '50s. And we may run out of rubber gloves. So we're going to have to have some way for people to sterilize their hands so they can safely do things. We've got to start thinking that way, I think."

Weighing on the minds of those deliberating is the fear that, while health-care workers will be desperately needed during a pandemic, some may refuse to show up for work if they feel they are not adequately protected.

Ontario nurses are already raising the issue, complaining that the federal government is stockpiling inexpensive surgical masks rather than the more costly N-95 respiratory masks.

The World Health Organization and the U.S. Centers for Disease Control currently recommend N-95 masks for health-care workers treating the rare but dangerous human cases of H5N1 avian flu. But neither group has issued recommendations on what they think should be the standard when the next pandemic hits.

Coming up with those policy recommendations is challenging.

There is almost no scientific evidence on whether wearing a mask cuts transmission during a flu pandemic. Pandemic strains of influenza are rare, they are different from annual flu strains, and they are different from one another. And modern protective devices weren't available during the last pandemic in 1968.

"It's just not settled the role that small particle aerosols" - the form of transmission best protected against with an N-95 mask - "will play in terms of a pandemic strain," said Dr. Martin Cetron, director of the CDC's division of global migration and quarantine.

Policy makers who are accustomed to issuing evidence-based recommendations are in the uncomfortable position of trying to find novel ways to devise guidance that is more than mere guess work.

Some are scouring medical histories, original source material from past disease outbreaks and even historical fiction looking for clues about how effective measures like the wearing of cloth masks across the face were during earlier outbreaks of infectious diseases.

"I find it very useful, not as a case control study, but as a historical reference point to study some of the original records from the various pandemic experiences and see: What did societies do?" Cetron said.

The Institute of Medicine, experts who advise the U.S. government, has been asked to investigate whether it would be feasible to develop reusable cloth masks, made of muslin, for use in a flu pandemic.

And those involved in discussions over the use of masks recognize their advice has to cover both what might be best if it is workable, and what might be an acceptable alternative if best isn't available.

"It's going to be important to establish the ideal and then plan for the real event," said Dr. Michael Osterholm, an infectious disease expert who has been warning of the amplifying effect the global just-in-time distribution system will have during the next pandemic.

"And the real event, we'll be seriously short of many of those essential goods and even some services that we count on on a routine basis," said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

The WHO faces the additional challenge of making recommendations for the world - for the wealthy G-7 countries, for mid-level economies and the poorest of the poor.

Under those circumstances, recommending health-care workers be protected by the Cadillac of medical masks is ensuring the poorest countries can't follow the WHO's advice.

"If you take that perspective, it means that a lot of practical considerations have to be on the table as well as scientific considerations. And then you take some mix of those factors to come up with the best guidance that you can come up with," said Dr. Keiji Fukuda, acting director of the WHO's global influenza program.

"You don't want to make recommendations that are simply the ideal. You want to make recommendations which are practical. They're usable. They're feasible."
    

http://news.yahoo.com/s/cpress/20060321/ca_pr_on_he/pandemic_medical_masks


    
    

My husband, who works for the local gov't is considered "essential personel".  He works in sanitation ... aka ... your sewer system.  He has never lifted a shovel, with the exception of a doggie dooo, since I've known him.  He is fully prepped with regards to the problem we are facing, and he WILL be on the front lines when or if this thing hits.....

I also work for the government (local) and am NOT essential personel, but I have started taking classes to get certified as and EMS employee.  I'm alreadly proficient in CPR and what/not.  I think that if this hits, and he has to go to work to make sure ya'll can poop without wasting your water, I can go out and do what I can do to help everyone else.

And neither of us are health care workers.

If malpractice lawsuits are such an issue.... join a group of Drs. to offset the cost.

I am afraid to die.  I'lll admit it.  But I"d rather die doing the greater good than hiding behind the threat of lawsuits!  What is that!

And you've already told your patients you're leaving.... give me a freakin break.  I know it's hard for physicians, but really... give me a break.  You are leaving because you f'ed up in real life or in someone elses mind, and that has left you ripe for lawsuits.

An oath, is sacred.  It is sacred if you have a bad year.  It is sacred if you have to live out in the boonies (like me) and stretch a budget.

If you stayed where you were at, kept your practice open, and saved just ONE life.... what cost, what price, would you put on that.

I'll bet the person who you ran away from treating and left this world would disagree with you on the final bill.... and I'll bet they would think it should be much higher for a chance to live.

But good luck to you in your quarantine.

P - word (that's "pussy" in case you misread it) ( And that was totally a message to DR (yeah.... right.... Dakota)

    
Canadians main defence in first six months of pandemic: hand-washing.

Canadian Press

Published: Monday, March 27, 2006

OTTAWA (CP) - Forget about vaccines and wonder drugs: The main weapon available to Canadians for the first six months of a flu pandemic will be soap and water.

After have studied all possible precautions for a pandemic which it figures could kill 58,000 people, Health Canada concedes that citizens can't do much to fend off infection except wash their hands. The information is available on a website devoted exclusively to the risk of a flu pandemic, launched by Health Minister Tony Clement at a rare news conference Monday.

The site says hand washing "is the cornerstone of infection prevention and may be the only preventative measure available during a pandemic."
Antivirals can be used to treat symptoms once a person is infected, but not to prevent infection.

Health Canada says people should have plenty of hygiene products as there may be "an interruption to the supply or shortages of hand antisepsis products, soap and hand towels."
A vaccine cannot be produced until the new flu strain has been emerged and been identified, says the website. It would then take six months to produce the vaccine.

"Therefore a vaccine will not be available at the start of the epidemic and may be in short supply during the initial stages."

A regular flu shot would be of no use against a mutated version of avian flu.

    Some experts have advocated a stockpile of surgical masks to prevent the spread of bacteria, but the website says masks are of no use once the disease has entered a community.


The website - www.pandemicinfluenza.gc.ca - has lots of company on the Internet. A Google search using the key words "influenza pandemic" produces a list of 7,410,000 sites.

Currently avian flu occurs almost exclusively in birds. There have been a few dozen human infections affecting people who deal with birds but there is no evidence the virus is spread from person to person.
Some scientists say the virus could mutate to produce a global disaster like the Spanish flu epidemic of 1918, but others say this is unlikely.
Clement denied that risks of the avian flu have been overdramatized. "If the worst occurs and a pandemic does strike our nation I think people would automatically look to me and say, 'Mr. Clement, how did you prepare for this?"'

"The expertise around the world says there will be another pandemic but there's not a single person who knows whether it's going to be tomorrow, next week or a hundred years from now."

Clement declined to answer questions about the care guarantees his party promised in the last election, identified in a poll this week as Canadians' top political priority.

"Please allow us the opportunity to have a speech from the throne, allow us the opportunity for Parliament to resume," he said.
The news conference is Clement's second in Ottawa since being named to the health portfolio. In the first, he promised to study Alberta's health proposals to determine if they contravene the Canada Health Act. It is not known when the government will give its opinion on that question.

The website says that without vaccines and antivirals, between two million and five million people would require medical care, between 34,000 and 138,000 people could require hospitalization and between 11,000 and 58,000 could die.

(Current population of Canada approximately 32-million.)


    http://www.canada.com/topics/news/national/story.html?id=a191d928-d62e-4528-87a5-bbe172ea7a77&k=24614


    
    
    

hye dakota sad, sad but very true.  all of the docs i have known as friends over the years have been people who have either lost their passion for their proffesion or still have it but can't handle hospitals, ingratitude, poor pay (seriously folks md s dont make sh*t, really0 and or lawsuits) that they are so burnt out they are either taking early retirement, activ ely seeking other work (or low pt contact work like group health) or are dissolving into drugs/alchohal.  seriosly we don't treat our docs (or nurses, or CNAs, or much of anyone in health care) worth a good god damn in this country.              

I worked as a nursing supervisor in charge of 100 post op patients in a physical/occupational therapy rehab.center.

The stress could KILL you.

The work is constant.

The stress was constant.

The responsiblity was huge.

Passing 100 meds an hour. IV's TPN's checking blood sugar levels/admin. insulin, regulating diet, wound vacs, dressing changes, inserting IV's and gastro tubes, hanging tube feedings, checking SAT rates, constantly having to deal with patients in isolation with VRE, MRSA and C.Diff, admin O2, calling docs, sending patients to the ER, tons of paperwork, charting on all patients, dealing with nasty family members, admin breathing treatments, emergency care, treating the psychotic, alzheimers, dementia, dying, on and on.


Now, add to that a staff cut by 65% and 20 times the patients, and wadda ya got.

Chaos.......insanity.

I sure hope anyone name calling medical personal will gladly step forward to volunteer "for the cause"

The problem is that the people on top, who make the "real money" aren't all too concerned for the patient's well being as they must know that staffing levels are way too dangerous.

Nurses are constantly putting their license on the line as they accept to work in conditions that folks who work in non medical professions would never tolerate but we are just so use to being treated this way, it seems the norm.

I feel if folks walked in our shoes a bit, they might have a change of heart.

Mary Kay RN

I can only think of one way to keep the hospitals open. Only one way to preserve some level of medical care in the western world. And while it might not work, I think it needs to be tried.

We simply need to accept that we cannot treat flu victims in hospitals. Period.

I know how that sounds. Cruel. Inhumane. Maybe even unthinkable.

But is there anyone here who believes hospitals won't look like the Superdome 4 days after Katrina, 48 hours into a pandemic?  Could there be any reasonable level of care provided under those conditions?

There are roughly 900,000 hospital beds in the US. And at any given time, 95% or more are already taken.   There are another 1.8 million people in nursing home beds.

We have nearly Zero surge capacity built into the system.  Vents?  105,000 in the U.S.  Probably 85%-90% in use already.   Estimates say we'd need 750,000 vents during a pandemic.  We've got about 10,000 available.

Come a pandemic, those 900,000 existing hospital patients, and 1.8 million nursing home patients, are likely to be the first casualties. EVEN IF THEY DON'T CATCH THE VIRUS.

If the HCW's don't report for work, these people will die.  Neglect and starvation are efficient killers, just like the virus.

Allowing Flu patients into the hospitals will only spread the disease to all patients, expose medical personnel to the virus, and bring the system down.  While I intend to help out in my community during a pandemic, I certainly wouldn't want to try to do that in a hospital overwhelmed with flu patients!   Hospitals will become flashpoints for violence.  There is more danger than just from contracting the virus.

A hospital, inundated with 2x or 3x times their capacity, with HCW's either unwilling or unable to come to work, will become little more than a centrally located body storage facility.

And anyone with appendicitis, or any woman in need of a simple c-section, or anyone injured and in need of trauma care will be out of luck.  Sorry, no rooms. No meds. No staff.

It would take a bold political decision, but in order to preserve some semblance of health care, all patients with flu like symptoms need to be turned away from the hospitals.  Curbside triage teams (with armed security) would need to evaluate every patient.  Those with fevers or non-cardiac respiratory difficulties get sent home.

Perhaps some ad hoc flu receiving centers could be setup in community centers and gynasiums, but believe me, you wouldn't want to end up in one.  Best place to ride out the flu, regardless of your outcome, will be at home.

This would be a bitter pill for the public.   But it's nothing more than Triage.  Saving those who can be saved, while accepting that some cannot.

And for this to work, the decision must be made now. Once a pandemic starts, it will be too late. A public information campaign needs to be put in place, telling people not to go to the hospital for flu symptoms. 

Even if we allowed hospitals to take in flu patients, in a severe pandemic, 90% of those who should be a medical facility will never see the inside of a hospital.   And I suspect they will be the lucky ones.  Not much a hospital is going to be able to do for a flu patient. 

You want an operating room available for your kid if their appendix bursts, or a trauma center open to care for a firefighter who's burned trying to stop a conflagration?  The only way that will happen is if we reserve our medical facility for non-flu patients.

And perhaps, HCW's would feel differently about working, if they knew they were working in a largely flu-free zone.  Sure, some patients may get past the triage point. And regardless of their other medical issues, they will need to be moved out as soon as they are discovered.  

Will it happen?  I doubt it.  I doubt we have the political will to do such a thing.

It will be easier to let the system fail, than to do the one thing that might preserve it.

A pity. 

SARS prepares Toronto for bird flu

Wed Mar 29, 2006 8:00 AM ET

(Page 1 of 2)
           
TORONTO, March 29 (Reuters) - Toronto's deadly brush with the SARS virus three years ago has uniquely prepared the city for the possibility of a bird flu pandemic, health officials say.

Drawing on lessons from the 2003 outbreak of Severe Acute Respiratory Syndrome, city and provincial experts promise new screening measures, emergency plans to treat patients from home and tough laws detailing what health workers must do.

Rules still under government debate could ban travel, fix prices and order health-care professionals to provide necessary services in the event of a pandemic.

"I think what puts us ahead of folks who haven't dealt with SARS is that it really has made the potential pandemic more real. We at least have a framework for what we might see with pandemic flu," says Dr. Susan Poutanen, primary author of the first two scientific papers on SARS, published in The New England Journal of Medicine during the Canadian outbreak.

Toronto was the only city outside Asia where people died of SARS. The disease infected 375 people in the city, Canada's largest, and killed 44, prompting a scathing public inquiry and angry lawsuits.

And it could be only a matter of time before Toronto has to cope with bird flu too, as the H5N1 avian influenza virus spreads out of Asia to infect birds in Europe and Africa. Experts agree it will one day reach North America too.


LONG-DISTANCE CARE

Ontario's influenza plan aims to free up overwhelmed hospitals by providing telephone and Internet home care to less vulnerable patients.

Late last year, the provincial government proposed legislation that would broaden its power to ban travel and order health workers to provide services if a pandemic struck.

But Ontario's Bill 56, which is still being debated, has drawn criticism from doctors who fear they will be jailed or fined if they refuse to work.    

"My initial response when I think about (avian influenza) is that I'd like to run away from it all and protect my family, and that's the sense I get from my colleagues," said Connie Leroux, a nurse who contracted SARS from a patient at a Toronto hospital.

"However, I also have a very strong sense of responsibility to our community and our patients, so I'm not sure how many of us would actually leave -- including myself."

Poutanen, an infectious disease consultant at Toronto's Mount Sinai Hospital, named surveillance and diagnosis as key areas where Toronto learned from SARS.

"Surveillance for fever and respiratory illnesses ... has gone from essentially nothing to an Ontario-wide suggestion that all hospitals search (them) out," she said.

Hospitals in the province of 12.5 million will question anyone who arrives with a respiratory illness, even isolate them until the symptoms are deemed noninfectious.In 2003, hospitals overlooked a single case of SARS, setting off a second deadly wave of the disease and landing thousands in quarantine.

One of those quarantined was Leroux. Now 35 and diagnosed with depression, anxiety and post-traumatic stress, Leroux says she followed guidelines for both protective attire and contact with her family.

"It was very clear to me that (my husband) and two children were at high risk of contracting it as well because I had just seen them and was quite contagious at the time," she said in an interview.

Leroux's family did not contract SARS, but they spent 10 days in isolation, while she was quarantined for a month. The nurse is now one of 53 suing the provincial government for negligence during the crisis.

TRUMPING MOTHER NATURE?

A public inquiry blamed a "broken" public health care system in its interim report, calling it "unprepared, fragmented, poorly led ... inadequately resourced."

"SARS was contained only by the heroic efforts of dedicated front line health care and public health workers and the assistance of extraordinary managers and medical advisers," Justice Archie Campbell wrote in 2004.

Ontario that year committed C$2.4 million ($2 million) in new health spending and created an emergency management unit to coordinate the province's response to crises like SARS.

http://today.reuters.com/investing/financeArticle.aspx?type=bondsNews&storyID=uri:2006-03-29T130105Z_01_N27263358_RTRIDST_0_BIRDFLU-CANADA-GENERAL-FEATURE.XML&pageNumber=1&summit=


    
    

    

asatrape wrote: And if you're in Canada, and faced with huge fines and jail time, come to the US.  God knows we used you during Vietnam.

"The Institute of Medicine, experts who advise the U.S. government, has been asked to investigate whether it would be feasible to develop reusable cloth masks, made of muslin, for use in a flu pandemic."


"You don't want to make recommendations that are simply the ideal. You want to make recommendations which are practical. They're usable. They're feasible."

http://news.yahoo.com/s/cpress/20060321/ca_pr_on_he/pandemic_medical_masks

* "made of muslin" - Russian roulette sounds like it has better odds.



    
    
    
    

con**rned nurse wrote: HELLO ALL! IHAVE BEEN CHECKING THIS SITE FOR SEVERAL MONTHS AND PREPPING, THIS SITE IS A GREAT SOUR**. MY QUESTION, DOES ANYBODY KNOW WHAT WILL HAPPEN TO THE NURSES WHO ARE UNABLE TO GO TO WORK BECAUSE OF YOUNG CHILDREN WHEN THE BIRD FLU COMES. I LIVE IN INDIANA, AND AM VERY CON**RNED ABOUT MY CHILDREN, BUT ALSO ABOUT MY NURSING LI**NSE. IF ANYBODY KNOWS WHAT THE HEALTH CARE PROFESSION IS PLANNING TO DO TO NURSES WHO DON'T GO TO WORK BECAUSE OF KIDS, LET ME KNOW

    Any healthy medical professional that does not get ill, will be worth their weight in gold, any time anywhere. If you become ill and are unable to report for work, I'm sure they will understand and they will be happy to have you back when you are well enough. In my humble opinion, I don't think they want sick employees reporting to work.



    
    
    

dakota112 wrote: Maybe we should let this bunch of hooligan trial lawyers treat us all and risk their own lives when avian flu comes as I would not treat a plaintiff trial attorney. Many of my associates absolutely refuse to treat attorneys and they have earned this. They will beg to be treated when this contagion hits. I'm gonna cry.

 janetrn, thankyou for saying it so well. roxy

Janetn: You are right... we all need to stand up and do something about it.

How many of you who work in the in the medical field and would be willing to work in a pandemic; have banded together to asked for proper protection during a pandemic?

How many of your fellows have done prudent H5N1 research; assuring that we can deal with this virus in the best possible way with limited resources.

 

If not... have you confronted them about thier failure to address this very significant problem? 

 

We cannot do something about H5N1... If we decide to do nothing!

 

I plan on making some trips to the local hospitals asking questions. I also plan on reporting what I find to the media!

 

I also plan on addressing this with my local and state officials.  

 

I have discussed this with my friends who are doctors and my own doctor.  Some are choosing to sick their heads in the sand; while some are on this site... and other medical sites looking for the best possible way to help their patients.

 

 

 

 

 

 

 

 

One thing to look at is, if it gets as bad as some say it will, hospitals, sports stadiums and other large places will be filled to overflowing with sick and dying.

 Where is the responsibility of people who have more clout than most -use your influence , write letters ,-> do something , but stop complaining.

Tamiflu is useless

Actually, the oath a lot of health care and essential workers will take is the one you take after you receive the letter from the government starting with "GREETINGS!  You have been inducted into the US Army."  Expanding the rules that recently let them recall ex-military and guard, even much older people, will be a trivial thing to do.

It is.  Certainly as hypothecal as a H5N1 Pandemic.