# 580
JEMS, The Journal of Emergency Medical Services, is the lead professional journal for EMT's, Firefighters, and other emergency personnel. Today there is an article on how healthcare workers would respond during a pandemic.
First the article, then a bit of discussion.
Will Emergency Health Care Providers Respond To MCIs?
Syrett J, Benitez J, Livingston W, et al: "Will emergency health care providers respond to mass casualty incidents?" Prehosptial Emergency Care. 11(1):49-54, 2007.
The Science
This study was conducted in a medical center in upstate New York that was designated as a major receiving center in the event of a major biological terrorist event. The study was conducted through random anonymous surveys of healthcare professionals, which included emergency medicine physicians, nurses and EMS personnel.
Surveys offered two scenarios. Both scenarios started out with the report of a flu-like infection that caused some healthcare workers to become ill. At some point, the participants were made aware that this was terrorist event. The two scenarios then differed. In the first case, the agent was determined to be non-transmissible and had an effective treatment and/or prophylaxis. In the second scenario, the agent was determined to be transmissible with only an experimental treatment. The participants were asked at various points in the survey if they would respond to work if called.
The researchers discovered that initially almost 80% of the survey takers would respond to work. However, when it was determined that the agent was transmissible with no proven treatment, the response dropped to 18%. The most significant factor that influenced their decision was the availability for treating their family members if they were to report to work. This resulted in a doubling of response to work in both scenarios.
For nearly two years, we've heard from `official' sources that hospitals and emergency services could see as much as 40% absenteeism during a pandemic. Scenario # 2 in the article above. That number is derived from those who are expected to be sick, or caring for a loved one who is sick. It doesn't address the issue of a reluctance to work in a pandemic.
And for as long as I've been writing this blog, I've maintained we'd see absenteeism closer to 60%-70% in a severe pandemic.
It seems, based on this survey, I've been an optimist.
Before anyone damn's these workers for failing to do their jobs, consider this:
Most hospitals and EMS facilities have done little to provide for the protection of their staff should a pandemic erupt. Very little stockpiling of PPE's (Personal Protective Equipment) has been done to date. A year ago, there was talk about giving HCW's (Health Care Workers) prophylactic Tamiflu to ward off infection, but that now seems to have been abandoned as too expensive or `impractical'.
Most Hospitals will run out of PPE's (masks, gowns, gloves) within a few days or weeks of the onset of a pandemic. Asking health care workers to expose themselves under those conditions is the same as asking a firefighter to rush into a burning building without their bunker gear.
Most of these people have families. If they expose themselves at work they have two options. Either quarantine themselves in the hospital for the duration of the pandemic, and leave their families to fend for themselves, or risk bringing it home to their spouse and kids.
Remember, a pandemic wave can last for months, and we could see multiple waves over a period of two years.
Another big issue will be security for these workers. In a pandemic scenario, where health care will be severely rationed, there will be many people who will not take kindly to being told their are no hospital beds, ventilators, or antivirals for their loved ones. EMS crews, doctors, and nurses are rightfully concerned about how these people will react, and serious consideration must be given to providing armed security.
If officials want to even come close to only seeing a 40% absenteeism rate they need to start providing for Health Care workers and their families. That means adequate PPE's, antivirals, security, and finding creative ways to protect families of workers while they do their jobs.
If the hospital system fails, and it would with only 18% staffing, then the cascade effects would be overwhelming. Will LEO's (Law Enforcement Officers) or firefighters report to work if they know that should they be injured, there would be no one to care for them? Highly unlikely.
Every year, millions of people are hospitalized in this country with life threatening conditions. Heart attacks, strokes, accident victims . . . and these people would have no recourse for medical care if the system fails. The collateral damage, deaths from non-flu related causes, would soar.
Not asked in this survey, but also likely to be no-shows, are the support personnel at hospitals. Housekeeping, cafeteria, clerical, security, and lab personnel. A hospital can't function without these people either. Just how willing will a minimum wage food service worker, or housekeeping employee, be to report to work when they see half or more of the medical staff as no-shows?
There is likely some point of critical mass where when a certain number of employees fail to show, the rest will abandon their posts. I don't know what that number is. 50%? 60%? 70%? When it becomes obvious that those who remain at work are no longer capable of rendering effective aid, and they are losing the battle, most of them will leave too.
Can this scenario be avoided? Yes, I think it can.
But to do that we have to recognize that our emergency personnel, including LEO's and firefighters, are the thin line that separates us from total anarchy during a pandemic. If we ignore the special risks that they will be asked to take, and do nothing, we can't expect them to step up.
HCW's need to see action now, demonstrating that they are more than just expendable cogs in a multi-billion dollar for-profit machine. And that means spending the money for the supplies they will need, including antiviral medications. If Tamiflu is unavailable, then at least stockpile Amantadine.
It also means making provisions for their families during a pandemic. Perhaps each city will need to commandeer a hotel or two where they can all stay, and provide food, water, medical care, and security for them. It isn't a perfect solution, but it would help.
Yes, it would be expensive. Horrendously so.
But if you want to keep the lights on in the hospitals, and the streets patrolled by law enforcement, it's a cost we're going to have to accept.
Because, quite frankly, the alternative is worse.
