Wednesday, August 26, 2009

Doh! Danny Boy

 

# 3673

 

 

This morning an area of disturbed weather that the NHC had been following for a couple of days coalesced into a named Tropical Storm. 

 

Danny, the 4th named storm of the 2009 Atlantic Hurricane season, has the potential of threatening the eastern seaboard of the United States by the weekend.

 

image

Early track projections, particularly when a storm is just beginning to intensify, are often subject to serious error.   Over the next 12 to 36 hours I expect that we’ll get better guidance.

 

For now, those who live on the east coast, from about South Carolina to the Maritime provinces of Canada, need to be keeping a look out.  And anyone in the Bahamas should already be making preparations for possible storm conditions.

 

While it is too soon to know how much of a threat Danny will pose to the US and Canadian coastlines, it isn’t too soon to begin to prepare for his arrival.  

 

To that end, today would be a good day to visit FEMA’s Hurricane information page.

 

 

Hurricane Season 2009 - Be Prepared

With hurricane season starting on June 1st, FEMA is urging residents to be prepared for their personal safety and survival in case a hurricane threatens their community. To assist in these efforts, FEMA, along with the National Oceanic and Atmospheric Administration, is helping to raise awareness of steps that can be taken to help protect citizens, their communities and property.

 

 

  • FEMA Preparedness Overview (PDF 102KB, TXT 19KB)
  • The Declaration Process (PDF 28KB, TXT 6KB)
  • Urban Search & Rescue (PDF 27KB, TXT 3KB)
  • Disaster Emergency Communications (PDF 21KB, TXT 3KB)
  • Mobile Emergency Response Support (PDF 25KB, TXT 3KB)
  • Incident Management Assistance Teams (PDF 21KB, TXT 3KB)
  • Disaster Operations Directorate (PDF 24KB, TXT 6KB)
  • Logistics Management Directorate (PDF 36KB, TXT 9KB)
  • National Flood Insurance Program (PDF 24KB, TXT 6KB)
  • Use of Social Media Tools (PDF 35KB, TXT 12KB)
Are You Prepared?

Buttons and Badges and Blogs, Oh My!

 

 

#  3672

 

Social, or `new’ media describes a variety of ways to communicate using the Internet, and other new technologies, and has been embraced by the CDC and the HHS over the past year.

 

The video I highlighted in my previous blog is but one example of how the CDC is trying to reach the public with information about the H1N1 pandemic.

 

From humble beginnings around the first of the year, the CDC and HHS have accumulated hundreds of thousands of followers on Twitter, have set up social media pages on Facebook and Myspace, and continue to produce videos and podcasts which are becoming available on an increasing number of websites.

 

The arrival of the H1N1 virus has no doubt helped kick start these initiatives, with some of these agency twitter feeds seeing a 20 fold increase in followers over the past 4 months.

 

 

 

You’ll notice that I make liberal use of the badges and widgets offered by the CDC in my sidebar.   You can add these to your website, or social media page, as well.

 

image Si está enfermo no vaya al trabajo o a la escuela, quédese en su casa Cover your nose with a tissue when sneezing or coughing. Visit www.cdc.gov/h1n1 for more information. Stay home if possible when you are sick. Visit www.cdc.gov/h1n1 for more information. Wash your hands with soap and clean running water. Visit www.cdc.gov/h1n1 for more information.

The idea is that by `viral marketing’ the preparedness message can be amplified and multiplied across the Internet Spectrum.

 

The CDC’s social media page is large, and growing.   Take some time to explore the resources there. 

 

This is your tax dollars at work.

 

 

Novel H1N1 Flu (Swine Flu)

Sample Badge

On this Page

CDC Video Answers Vaccine Questions

 

 

# 3671

 

Dr. Anne Schuchat, Director National Center For immunization and Respiratory Diseases (NCIRD), at the CDC has a newly posted video on YouTube where she answers a number of question on the pandemic vaccine being developed for this fall.

 

This is part of the CDC’s move into the `new media’ available on the Internet, and is just part of the public education program that will be implemented by public health officials during this pandemic.

 

Nursing Survey Shows Hospital Deficiencies

 

 

# 3670

 

For anyone who has never worked in, or around a hospital, there is one truism they should know. 

 

Doctors and administrators don’t run hospitals.

 

Nurses do.

 

They may not control the purse strings, and may not set policy, but they do provide more than 90% of the patient care in hospitals.  While doctors get the glory (and the money), nurses are the glue that hold the medical world together.

 

Don’t believe me?  Try running a hospital sometime without them. See how far you get.

 

The outrage (and I’ll be writing more about outrage in the future) being expressed by nurses right now is important, and hospital administrators and policy makers ignore it at their own peril.  

 

Simply put, many HCWs (Health Care Workers) fear that their safety, and the safety of their patients, will be compromised during this pandemic.  They point to deficiencies in preparation by their workplaces and recent moves to certify surgical masks as `good enough’ personal protection for caregivers.  

 

Memories of the 2003 SARS outbreak, where some nurses died, remain fresh and vivid.  Some hospitals stood accused of failing to protect their employees with proper PPEs (Personal Protective Equipment) during that outbreak, and some nurses fear a repeat of that tragedy.


A few of the recent blogs I’ve done on this subject include:

 

IOM Meeting On PPEs For HCWs
IOM PPE Workshop Webcast Continues
Nurses Protest Lack Of PPE’s
Though Your Mask Is Lovely It’s The Wrong Mask
Report: Nurses File Complaint Over Lack Of PPE
California Nurses Association Statement On Lack Of PPE
HCPs At Risk
 

Today the CalNurses/NNOC organizations have issued a press release on the findings of a recent poll they conducted on hospital readiness for a pandemic. 

 

 

 

Many Hospitals Are Not Ready for H1N1: Nurse Survey Shows Deficiencies in Hospital Swine Flu Readiness

 

Data from 190 Healthcare Facilities in Nine States from California to Maine

OAKLAND, Calif., Aug. 26 /PRNewswire/ -- A patient health and safety survey of 190 American hospitals from coast to coast compiled by registered nurses in eight different states finds that a disturbing number of our nation's healthcare facilities are not prepared for the coming H1N1/swine flu pandemic, according to results released today by the California Nurses Association/National Nurses Organizing Committee.

The data reflects a survey conducted over the past four weeks by RNs in hospitals in Arizona, California, Florida, Illinois, Maine, Minnesota, Nevada, Pennsylvania, and Texas.

What the RNs reported are wide gaps in safety gear, infection control training, and post-exposure procedures. Among key findings:

  • At more than one-fourth of the hospitals, nurses cite inadequate isolation of swine flu patients, increasing the risk of infection to others.
  • Nurses at 15 percent of hospitals do not have access to the proper respirator masks, exposing nurses and patients to infection; at up to 40 percent of the hospitals, nurses are expected to re-use masks, in violation of Centers for Disease Control Guidelines.
  • At 18 percent of the hospitals, RNs report that nurses have become infected; one Sacramento, Calif. RN has already died.

CNA/NNOC is calling on all hospitals to adhere to the highest standard of protection for patients and nurses to combat the expected onslaught of new cases this fall and winter, and urging legislators to strengthen public protections.

"These continuing problems increase the risk that many hospitals will become vectors for infection, with inadequate patient protections leading to a spread of the pandemic among other patients, their friends, family, and caregivers, and the surrounding community," warned Deborah Burger, RN, CNA/NNOC co-president. "What we're hearing from around the country is dangerous to patient health and safety, but with smart and clinically appropriate leadership we can fix policies in time for the upcoming pandemic."

Among other findings:

  • At 19 percent of the hospitals all or some appropriate N95 respirator masks were not "fitted" to ensure their effectiveness against the virus.
  • More than one in five, 22 percent of the facilities, do not have enough masks, say nurses.
  • Nurses at fewer than half of facilities report that they have been adequately trained on H1N1 issues, including identification of infected patients, and procedures for caring for these patients.

To help combat these problems, CNA/NNOC called for:

  • Minimize infection of hospital patients and workers by strict adherence to the highest standard of infection control procedures, including identification and isolation with appropriate ventilation of infected patients.
  • All hospital workers and visitors must be provided with appropriate protection gear at the highest government standards, including N95 respirator masks or better for all who enter the isolation room of a confirmed or suspected H1N1 patient.
  • Any RN who is unable to work due to contracting a communicable or infectious disease identified or treated in his or her hospital/clinic shall be guaranteed sick leave, not face disciplinary action, and shall be presumptively eligible for workers' compensation.
  • Implement a moratorium on any closures of emergency rooms, layoffs of direct healthcare personnel, and reductions of hospital beds.
  • Federal guidelines for protection must be developed that are consistent across agencies.
  • Disposable respirator masks must not be re-used. In the event of a demonstrated national mask shortage, facilities should adhere to government recommendations on mask conservation.

For more details, see www.CalNurses.org.

CNA/NNOC is the largest and fastest-growing organization of RNs in the U.S. with 85,000 members in all 50 state

Tuesday, August 25, 2009

BMJ: 50% Of HCWs Would Refuse Vaccine

 

# 3669

 

 

In what is turning out to be a distressingly familiar story, we learn of another study where a majority of HCWs (Health Care Workers) would forego taking a pandemic vaccination out of fears of adverse side effects.

 

This sentiment is shared by a good percentage of the public, as well.  Over the past couple of weeks we’ve had other studies on this issue, which I covered in :

 

A Self Inflicted Flu Shot Wound

HCWs: Developing a Different Kind Of Resistance

 

With the HHS relying heavily on the public, and no less importantly HCWs, accepting a vaccine this fall, these studies are no doubt worrisome.

 

While I understand some of the concerns being expressed, particularly among those who would be offered an adjuvanted vaccine, many of the fears I’ve heard expressed seem over-the-top. 

 

An unadjuvanted split virus vaccine should be no more dangerous with the novel H1N1 virus than any other seasonal flu vaccine. 

 

Are side effects possible?  Sure.  But they are unlikely to rise to anywhere near the dangers posed by contracting the virus.

 

The links in the BMJ excerpt aren’t working as I write this entry, but should be `live’ shortly. 

 

BMJ - helping doctors make better decisions

Research

Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels

Two questionnaire surveys conducted at WHO pandemic alert phases 3 and 5 found a consistently low level of willingness to accept pre-pandemic influenza vaccination among hospital based healthcare workers, especially in those working in the allied health professions. This is particularly surprising in a city where the SARS outbreak had such a huge impact. The intention to accept vaccination against H1N1 influenza (swine flu) in the study was less than 50% even at WHO alert phase 5. The accompanying editorial says that evidence from decades of seasonal vaccination suggests likely benefits and low risk of adverse events, and vaccination may also help to keep the healthcare system operating at maximum capacity throughout the pandemic.

 

This report from Bloomberg News.

 

Health Workers Reluctant to Get Pandemic Vaccine, Survey Shows

 

By Andrea Gerlin

Aug. 26 (Bloomberg) -- Less than half of health-care workers in Hong Kong are willing to be vaccinated for swine flu, a survey published today in the British Medical Journal found.

 

The proportion of doctors, nurses and other medical professionals who plan to be immunized against H1N1, the virus that causes swine flu, was 47.9 percent when they were polled in May, researchers at the Chinese University of Hong Kong wrote. The World Health Organization declared its second-highest pandemic alert level on April 29, signifying human-to-human transmission of H1N1 in at least two countries in one region.

 

“The prevailing sentiment is that people don’t want to get it,” Thomas Tsang, acting controller of Hong Kong’s Centre for Health Protection, said on Aug. 23 at a meeting on influenza organized by The Lancet medical journal, China’s health ministry and the WHO. “They are afraid of all sorts of side effects.”

 

Health-care workers will be among the first inoculated in most countries that have announced immunization programs when manufacturers begin delivering the vaccine in the Northern Hemisphere’s autumn. The WHO’s Strategic Advisory Group of Experts on Immunization recommended last month that countries immunize medical personnel first to keep health-care systems operating and then decide which other groups should have priority.

 

(Continue . . . )

Hospital Triage Rules Clarified

 

 

# 3668

 

Hospital Emergency rooms get slammed every winter with influenza cases, often overloaded to the point that they have to close to emergency traffic, simply because they can’t handle the load.

 

This year, with pandemic H1N1 expected to infect tens of millions of Americans, Emergency rooms may find themselves under even greater strain than normal.  

 

Finding ways to deal with an influx of patients (and their families), most of whom are either mildly ill or the `worried well’, while still providing emergency care to those who really need it will be a huge challenge.

 

The problem is, under the provisions of the EMTALA act (Emergency Medical Treatment and Active Labor Act), no one can be turned away from a `participating hospital’ emergency room until they have been at least examined, and stabilized (if necessary).

 

Which, while protective of patients in normal times, presents serious legal and logistical challenges to hospitals dealing with an influx of pandemic flu patients.

 

The CMS (Centers for Medicare & Medicaid) have issued new guidelines that allow hospitals to set up special flu triage centers away from their emergency rooms. 

 

I’ve not found the new guidelines which were reportedly sent to hospitals around the country yet, but I’ll post a link if I do.


This article, which appears in HealthLeaders Media, was posted by Chuck on FluTrackers.   Follow the links to read about it, and some of the caveats involved, in their entirety.

 

 

 

Feds Clarify Hospital Triage Rules in Event of H1N1 Frenzy

Cheryl Clark, for HealthLeaders Media, August 25, 2009

Hospital and public health officials who worry about being deluged this fall by sick and worried well patients fearing H1N1 now have comforting federal guidance on how to re-direct crowds without violating the law.

 

First, jammed hospital emergency departments can set up alternate screening sites elsewhere on campus, with personnel stationed outside the emergency department to log in and redirect patients seeking care to that alternate site.

 

This triage system is acceptable as long as the personnel are qualified physicians, RNs, physician's assistants or nurses trained to perform such exams.

Second, hospitals may set up screening at an off-campus site if it is controlled by the hospital. And hospital and community officials may encourage the public to go to these sites instead of the hospital for screening for influenza-like illness.

 

Third, hospitals and community health officials may encourage the public to go to those sites instead of the hospital for influenza screening.

 

And fourth, the required medical screening exam does not need to be an extensive work-up in every patient's case.

 

The guidance was issued in a fact sheet distributed to hospitals by the Centers for Medicare and Medicaid Services in response to hospital and agency concerns.

(Continue . . . )