# 1993
Undoubtedly, one of the best parts about being a blogger on pandemic influenza and emerging infectious diseases is the people I meet, either online or in person. As one might suspect, many of these people are in the health care, or emergency response field.
Coming from this sort of background myself, these are people with whom I identify strongly. We speak the same language, and have shared many of the same experiences. I am particularly delighted when I get to meet these people in person.
I remain humbled and grateful that so many nurses, doctors, fire fighters, and LEO's (Law Enforcement Officers) have taken the time to not only write, but to alert me of their concerns, and to offer suggestions. Sometimes these exchanges come as comments to this blog, but most of the time, it is through private email.
Yesterday, AnnieRN posted a series of suggestions on my blog about OSHA's Proposed Guidance on Facemasks and Respirators. Annie and I have corresponded many times in the past, and she is a frequent and valued commenter here.
In order to give her ideas a better airing, I've decided to reprint them here.
#1. It's important that first responders and medical personnel have these supplies in their cars so that they can put them on before they enter any hospital or other health facility. There's no point in grabbing the flu-contaminated doorknob to go into the virus-laden hospital air, then putting on the mask.
#2: Hospitals and clinics need to designate--and maintain--"flu only" entrances and, if possible, off-site clinics (in all of those no-longer-needed FEMA trailers?) No point in contaminating an entire hospital for the sake of the people who need flu care.#3. And about those FEMA trailers--I mean mobile flu clinics; they could be staffed and sent to rural crossroads, so that sick people could be treated, away from large numbers of healthy urbanites.
#4. How about making hospitals "no-go" zones for people with the flu? The problem with hospitals is that they are too much like non-moving troop ships in 1918--too much air space inside, and too many open corridors. Keep the flu-patient spaces small, to minimize transfer of contaminated air. Use mobile homes, semi trailers, etc. for flu treatment, and let hospitals be used for non-flu patients? (I know--this one is WAY, WAY outside the box...) Thanks! AnnieRN
These are all intriguing suggestions, and well worth discussing.
PPE's either need to be supplied to HCW's as they leave the hospital, or there needs to be an `employee's only' entrance where they are handed out prior to entering the facility.
During a pandemic, it only takes one small slip when working in an infectious environment to become infected. Annie's suggestions here make perfect sense to me.
As for #2, I'm assuming that entry into hospitals will be tightly controlled. That there will be parking lot triage performed, and that only select patients will be admitted. Of course, we know about the word `assume'.
It makes sense, if you are going to be treating flu patients in a hospital, to sequester them in a separate wing, or floor, to keep them from infecting non-flu patients. Whether or not most hospitals are dealing with this in their pandemic plans, is hard to know. Each hospital appears to be on their own, regarding their planning.
The much maligned FEMA trailers, most of which must have offgassed their excessive formaldehyde by now, may well have some use in a pandemic. I can see them as being temporary sick rooms, mobile dispensing clinics, or onsite residences for HCW's and their families during a pandemic.
Lastly, the suggestion that hospitals simply bar flu patients, and divert them to other facilities or send them home, is radical, but one that I've spoken of before.
The assumption is that 95% of all flu patients will be denied hospital care. That's right, only 1 in 20 flu patients is likely to be hospitalized in a pandemic. Those five percent, though, could bring many hospitals to a crashing halt, denying care to non-flu patients.
During a pandemic that lasts a year, millions of Americans (or, pick any country) will have health crises that are not connected to influenza. Pregnant women will still require C-Sections. Kids will need appendectomies, and there will still be heart attacks and strokes. There will also be trauma cases, and many people will require dialysis or radiation treatments to keep them alive.
It may not be possible, with a 3 to 4 day incubation period, to keep flu patients out of a hospital. A heart attack, or a pregnant woman, could enter the hospital without symptoms and 48 hours be infecting their entire floor. But once detected, flu patients could be isolated, moved to another facility or sequestered in `flu ward' in the hospital.
In communities with more than one hospital, it may make sense to keep at least one facility a `non-flu' hospital.
These are some of the tough decisions that hospital administrators, emergency managers, and health care professionals hope they never have to make, but are sure to become an issue in a severe pandemic.
Annie, thanks once again for your insight. Hopefully this will inspire pandemic planners who are reading this to consider some of these options.
