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ER Docs Will See H1N1 First—Don't Ignore Their Warnings

Cheryl Clark, for HealthLeaders Media, July 8, 2009

Cantrill says these are three areas where hospitals are most vulnerable in the event of a pandemic attack:

Number one, Cantrill says, "is staffing. In a disaster like Katrina, you had people from around the country willing to come in and help out. But if the next outbreak is broadly population based, you will lose not only many members of your own staff, but the vast majority of your volunteers."

Hospitals need to start now to mobilize teams of nurses and physicians, even if it means recruiting those retired but who kept their licenses active.

Number two is supplies. Far too many hospitals are using "just-in-time" purchasing policies that will leave them scrambling for masks, gloves, gowns and ventilators, not to mention antibiotics and IV equipment, if a 1918-level flu season strikes.

"If you do the numbers of what would be required for a sustained pandemic, it just strikes fear in the heart of anyone who has looked carefully at this problem," say Cantrill, an emergency room physician at Denver Health Medical Center in Colorado.

"There would be a disruption in our supply chain." And hospitals that normally compete with each other will not be willing to help out if they themselves are running short too, he says.

Number three is communication. Hospitals and public health officials must have a routine, constant communication stream, a conduit he says has historically been a weak link. But the involvement of public health officials is essential to reassuring the public and the media, notifying patients when to go to the hospital, and when to stay away.

At his hospital last April, "the number of patients in our emergency department with respiratory complaints increased by a factor of three. It was overwhelming and debilitating and public health officials need to know about that, and do what they can to offload on other facilities," Cantrill explains.

Lastly, he says, is to imagine the worst. Hospital officials at all levels of care need to dust off their protocol books and spend some time thinking about how such a scenario would really play out when resources are stretched thin.

It's tough to think about, he says, but each hospital needs to have a plan, and a chain of command, for deciding how to triage patients for life-saving care. Who gets a ventilator and who doesn't when there aren't enough to go around?

"We only have 105,000 ventilator in the U.S. and we would need six times that if we had a true pandemic," Cantrill says. "Hospitals are going to have to look at way to prioritize when we have limited supplies."

"These are tough ethical questions," no one can dispute, he says. And while some states and regions of the country have "really taken the bull by the horns," others have not.

The emergency room doctors have turned up the volume of their message. Maybe it's time to listen up.


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Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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