We’re 10-97. Now what?
# 210
Note: Today’s enigmatic title refers to the 10-code used by many emergency services in the US to designate `arrived on scene’.
A year after the swine flu scare of 1976, the world was hit by a fairly nasty strain of influenza. No, it wasn’t a pandemic in the traditional sense, but it was a very heavy flu year. And it had serious ramifications for hospitals and emergency services.
Emergency rooms were overflowed, and hospital beds were in short supply. I can remember being `re-routed’ numerous times in my ambulance, after picking up a patient, because our destination hospital either had no beds available, or the ER was inundated with patients.
This begs the question: What will emergency workers do in a pandemic situation?
Despite plans here in the US for all but `the sickest of the sick’ to be treated at home during a pandemic, hospitals will likely be deluged with patients. To date, we are unaware of any `mild’ cases of H5N1 Avian flu, and the average hospital stay for an infected patient who survives has been on the order of a month, and they routinely require extraordinary efforts to keep them alive.
The burden that a pandemic would place on our health care infrastructure is almost unimaginable. Add to that the likelihood that 40% or more of hospital staff will be out sick with the flu, or taking care of a loved one, and their capacity erodes even further. And frankly, from my discussions with healthcare workers, if we see 50% remain on the job I will be surprised.
Assuming hospitals can remain functioning at all under these conditions, at some point, they will have to turn away patients. We have roughly 1 million hospital beds in the US, 90% of which are occupied at any given time. Throw 30 million flu patients into the mix, and well, you can do the math.
And of course, heart attacks, strokes, childbirth, and trauma cases will continue during a pandemic. If anything, they will rise. Even if it were possible to exclude flu patients from the hospitals, we haven’t the capacity to handle the load.
Now imagine you are an emergency worker; an EMT, or paramedic, and you are called to the scene. What do you do? The hospitals are full or shut down. You can’t transport, you’ve nowhere to go, and you certainly can’t stay and provide ongoing care.
The grim reality is you will have to give the family (assuming there is one) the best advice you can regarding patient care, and walk away. A recent poll indicated that 25% of adults had no family or caregivers they could depend on. What becomes of them?
Hopefully someone in authority is preparing home flu care guides to be dispensed from every ambulance, rescue vehicle, and fire truck. But if they are, I haven’t heard about it.
How families will react when they find that their child, or spouse, or parent won’t be transported to the hospital is unknown, but it’s fair to assume some nasty confrontations will occur. How long emergency workers will be able to work under these conditions is debatable. But at some point, I can see most of them shut down.
Even if they remain in operation, EMS crews will be hard hit by the virus, and they may find their supplies of gasoline, oxygen, and meds are quickly consumed.
The lack of resources during a pandemic will be a rude awakening to a society that is used to a reasonable standard of care.
And the problem isn’t restricted to ambulances and rescue trucks.
How will the police handle arrests and due process under a pandemic? Just like hospitals, the police force will see a high rate of attrition from the virus, as will the court systems, and jails.
If an officer arrives on the scene of a crime, and is able to apprehend a suspect, what then? How do you house and process criminals if the system designed to perform that function is broken?
Crime will presumably continue, even in the midst of a pandemic. If our experience in New Orleans after Hurricane Katrina is any indication, it will probably go up. Already stretched thin, how will any police force cope with a 40% absenteeism rate and a rising caseload?
Will crime scene units be available to process evidence? Will defense attorneys risk exposure to the flu and go out and represent clients? Will courts even be in session?
As you can see, a pandemic is more than a public health issue. It will affect every aspect of society.
No, I don’t have any obvious answers. I wish I did. But so far, I’ve seen little serious discussion of these issues.
And that worries me greatly.
If you find my blog of interest, there are a couple of others I can recommend to you. All three listed below bring interesting, and often controversial perspectives to the Avian flu dilemma.
SophiaZoe's Blog may be read at
http://birdflujourney.typepad.com/
And Monotreme's blog can be found at
http://tinyurl.com/ybhgv4
Lastly, the Revere's at Effect Measure provide a wonderful resource from the public health viewpoint
http://scienceblogs.com/effectmeasure/
