Preparing for a Pandemic

Despite the considerable attention the A(H5N1) virus is garnering from the worldwide scientific community, the likelihood of a bird-flu pandemic remains a mystery. With three influenza pandemics occurring within the past 100 years—the worst happened in 1918 with 50 million deaths—some emergency planners say it is not a matter of whether we will endure another pandemic, but when.

Speaking during a health summit in Washington, D.C., Michael Leavitt, secretary of the U.S. Department of Health and Human Services, said if a pandemic similar to earlier outbreaks were to take place now, 45 million Americans would require serious medical attention and roughly 2 million would die. “Any community that fails to prepare with the expectation that the federal government, or for that matter the state government, will be able to step forward and come to their rescue at the final hour will be tragically wrong,” Leavitt said.

In the face of such dire warnings, experts say few regions of the country are seriously planning for the next pandemic, and fewer still are working in conjunction with their area hospitals. Hospital CEOs can take a number of sensible measures, however, to improve their communities’ pandemic readiness, according to Thomas V. Inglesby, M.D., chief operating officer and deputy director of the Center for Biosecurity at the University of Pittsburgh Medical Center. “Most hospitals have not been central participants in community planning, even though they absolutely would be central participants in a response,” he says.

Here are five fundamental steps you can take to put your hospital—and your community—on the path to pandemic preparedness.

1. Get the conversation started. In a pandemic situation, emergency managers from public health agencies and the community will realize it’s in the community’s best interest to keep area hospitals running as smoothly as possible. While this is good news for hospital leaders, it’s far better to be seen as an equal partner rather than just as a resource, says Inglesby. It is critical for hospital CEOs to determine how to coordinate with regional and federal leaders and to ensure that a plan is in place to make requests for limited resources.

“If I were a CEO, I don’t think I’d wait to be invited to somebody else’s party,” says Dan Hanfling, M.D., director of emergency management and disaster medicine for Inova Health System, a $1.4 billion, five-hospital network headquartered in northern Virginia. Hanfling recommends bringing together your community partners from public health, emergency medical services and emergency management to voice your concerns and initiate an open dialog about community planning. “Healthcare leadership in this country needs to be much more pro-active in terms of directing the conversation and lining up the support that will be required,” he says.

2. Call a cease-fire with your competition. In Minneapolis, 370-bed Hennepin County Medical Center is the coordinating hospital in the metropolitan region for disasters, says John Hick, M.D., the facility’s medical director for emergency preparedness. In a time of crisis, Hennepin communicates all area hospitals’ resource and policy needs to the state’s regional manager of public health. “During a disaster, you cannot have 29 hospitals suddenly demanding individual resources from emergency managers,” he says.

Competing hospitals should see the area of pandemic preparation as a no-fire zone in their turf wars, says Hick, because collaborating on strategies for surge capacity and resource allocation is essential. When ventilators and antivirals are in short supply, a new standard of care will need to be created at the community level. “You can’t operate in a silo,” he says. “You need good situational awareness and cooperative engagement with other healthcare organizations.”

3. Pick a point person. A big frustration among hospital emergency planners is that pandemic planning isn’t getting the attention of senior leadership, says Hanfling. “This is every bit as important as healthcare facility strategic planning and economic forecasting, because it impacts all of those areas,” he says. Without involvement by senior leaders, an organization’s separate groups—from emergency planning to safety and security to infection control to employee health—could be preparing independently of each other. The CEO or COO should designate a point person to organize these groups and make sure important concerns are brought to the CEO’s attention, Hanfling adds.

4. Talk to your staff. One of the worst things anxious employees hear from leaders is silence. Find out your staff’s key concerns and communicate how you are addressing them. For example, in a study published in the April issue of BMC Public Health, 42 percent of healthcare workers said they would not show up for work in the event of a flu pandemic. “The more hospital leadership does now to explain how it plans to protect workers and minimize transmission, the better that institution will be,” says Inglesby. “If this isn’t anticipated, healthcare employees will be afraid and uncertain and make choices to try to protect themselves and their families and decrease the hospital workforce.”

For instance, a hospital might plan to provide hotel accommodations to clinical workers who are afraid of infecting their families, says Hick. In addition, sharing plans in advance for cohorting infected patients and providing respiratory equipment can ease employees’ tensions.

5. Don’t forget your other patients. If hospitals face a crisis of the 1918 pandemic’s proportions, they will encounter numerous ethical and procedural dilemmas. Ultimately, CEOs must figure out how to deal with avian flu patients in a way that doesn’t shut down the rest of their hospital.

“Without very serious planning, it could be that avian flu patients are so complicated to manage and create such a new dynamic within the hospital that the hospital won’t be able to take care of all the other routine and anticipated problems within the community,” says Inglesby. “Leadership has to have an overall plan that ensures the hospital will still be able to perform its key functions so the community doesn’t lose the institution it depends on for delivering babies and preventing people from dying of heart attacks, strokes and diabetes.”

In short, taking steps to prepare your hospital now for the next major pandemic can help keep frontline clinicians from making rash judgments, say experts. If critical decisions are not formed at the community and institutional level, they will be left to overwhelmed doctors and nurses tending to the sick and injured in a time of catastrophe.

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Not Your Run-of-the-Mill Crisis

“There’s no cavalry coming,” says John Hick, M.D., medical director for emergency preparedness for Hennepin County Medical Center. “Basically, you have to rely on what you have internally, and predicting that supply lines might be down, you’re going to have trouble getting your usual supplies.”

Disrupted supply lines are just one way a pandemic might differ from other disaster scenarios. Hick points out that mass-casualty disaster drills for warehouse explosions and bus crashes won’t prepare a hospital for the stress of the next pandemic. For one thing, even though providers will be able to see a pandemic coming, they won’t be able to adequately prepare for it. “It’s on a timeline that no other disaster is on,” says Hick. “It’s going to go on for months or the better part of a year, as subsequent cycles of the disease come through.” This could present an extreme test of the hospital’s employees as they attempt to maintain services under tremendous duress on a protracted timeline.

Another key difference from other disasters that hospitals would face is that the inflicted won’t “die at the scene,” says Hick. “They all die of sepsis or respiratory failure, and that means that nobody improves quickly because it’s an infectious disease.” This will create even more strain on a hospital’s inpatient system. Consider, for instance, how the SARS outbreak affected hospitals, causing patients to stay in the intensive care unit for 10 to 15 days. “You have to have really good plans in the community about how you’re going to deal with a lot more patient volume and how you’re going to provide a lot more care at home and other locations where you wouldn’t normally provide care,” he says.

Rick Johnson is associate editor of HealthLeaders Online News. He may be reached at rjohnson@healthleadersmedia.com.