Some EDs fell short in H1N1 outbreak
Make changes before possible fall surge
When the H1N1 virus hit the United States this spring, some EDs were "caught unprepared," according to one emergency medicine expert, and many agree that changes must be made before the virus gains strength this fall, as predicted by the Centers for Disease Control and Prevention (CDC). In fact, the CDC recently predicted that the virus could end up affecting as many as 40% of Americans.
"Some EDs were caught behind in regard to their ability to manage both the volume and the clinical issues that were brought about," says James J. Augustine, MD, FACEP, director of clinical operations at Emergency Medicine Physicians, an emergency physician partnership group in Canton, OH, and a member of the emerging diseases committee of the International Association of Fire Chiefs in Fairfax, VA.
Some ED managers did not realize how very dramatically volume can turn up in regard to an infectious disease outbreak, Augustine says. "We need to be prepared for this fall and for potential future outbreaks of diseases," he says.
Others agree. "Even now, call volume in major medical areas is 20%-30% above normal, so it will call for some very unique approaches," says Mike McEvoy, PhD, REMT-P, RN, CCRN, EMS coordinator, Saratoga County, NY, EMS director, New York State Association of Fire Chiefs, and clinical associate professor, critical care medicine, at Albany (NY) Medical College. "It will be a challenge for all of us to think outside the box about how to conduct business as usual while dealing with an onslaught of worried people — not to mention the number people who are actually sick," McEvoy says.
In addition, says Augustine, there also were some difficulties in differentiating H1N1 from other sources of respiratory illness. "You've got to stay up on the latest guidelines," he asserts.
Finally, Augustine says, "Some EDs were caught off guard not just in terms of the volume rush, but availability of protective space to keep patients away from each other. They were not ready to deal with patients who needed respiratory isolation both as they arrived and as they needed care later on."
McEvoy says the ultimate challenge for hospitals and emergency medicine is going to be if something were to occur that causes facilities to be ultimately overwhelmed with patients. "Then how are we going to respond?" he poses. From an ambulance perspective, he says, the system will be crushed. "Not only will we not have the staffing necessary, but we won't have the hospital beds to bring them to," he says.
Augustine offers these recommendations to help ensure your ED will be prepared this fall should the anticipated surge in H1N1 cases come to pass:
• Hold meetings with local public health and other emergency planners to make sure you have developed community plans for an outbreak.
Make sure they have knowledge of and are able to apply the region's vaccination program for patients and especially staff. "ED staff and EMS providers should be high on the list of priority patient groups," says Augustine.
• Develop physical space that will allow appropriate isolation for patients with respiratory infections, so that staff and other patients can work effectively and be treated comfortably.
This step could include putting in additional patient rooms or developing negative-pressure areas. "Some EDs have developed a process for greeting patients outside the doors or near the doors, so they do not sit inside [the department] for a long time before they are recognized and placed in an appropriate area," says Augustine.
• Meet with the appropriate members of your ED staff along with the hospital infection control professional. Use their feedback to assist in developing procedures for use of personal protective equipment (PPE) and to gain cooperation in developing appropriate control measures.
"That is a changing element; we're not quite sure what the recommendations will be for N95 vs. other types of masks and when gowns and goggles will be needed," Augustine says, "But basic approaches should be developed, staff should be reassured that planning will occur, and then finally, you must educate the ED staff and associated workers." (Editor's note: For more information, go to the CDC H1N1 web site, www.cdc.gov/H1N1FLU. On the left side, click on "Info for Specific Groups." Next, click on "clinicians." Then, under "Guidance for Patient Management," click on "Infection control in a health care setting.")
• Hold discussions with human resources and the hospital's financial officials about appropriate quarantine and isolation procedures for staff members who have been exposed or who are ill.
These procedures can be extremely challenging, says Augustine. "You might decide to send people home or keep them home, or not allow them to report to work, and they'll say they need the income and they don't feel that bad," he notes. "These are very difficult discussions. They really need to occur ahead of time and should be consistent with what's going on in the rest of the hospital and perhaps the community at large." (For more information on dealing with sick staff, go to www.cdc.gov/h1n1flu/guidelines_infection_control.htm.)
Here are some tips for media relations In recent months, the media had an insatiable appetite for news about the H1N1 virus, notes James J. Augustine, MD, FACEP, director of clinical operations at Emergency Medicine Physicians, an emergency physician partnership group in Canton, OH, and a member of the emerging diseases committee of the International Association of Fire Chiefs in Fairfax, VA. While news reports might have reminded people to wash their hands and cover their mouths when they cough, they've also spread enough misinformation to prompt thousands of unnecessary ED visits. "During an epidemic threat, emergency physicians have an opportunity, perhaps even an obligation, to work with the media in a productive way," says Augustine. He offers the following tips for dealing with the media: • Take every opportunity to work with the local media on health care stories. To the best of your ability, have them come to your ED for stories on heat illnesses, fireworks injuries, lightning and storm dangers, mosquito-borne illnesses, heart attacks, and strokes. Build bridges with your hospital communication staff and the local members of the media. • Conduct a press conference and develop a template for media events and public service announcements that relate to hospital emergency care. • Work with public health agencies in your area on any messages that relate to emergency care, and allow them to use the ED as a backdrop for any media releases they want to do on general community health issues. • Access and use documents and releases from the Centers for Disease Control and Prevention (CDC). (Editor's note: For more information, go to the CDC H1N1 web site www.cdc.gov/H1N1FLU.) • Develop a reputation for helping the local media get the correct and accurate details on health stories. Infection control stories are very complex and require the best communicators to convey a clear message to the community. Develop the releases and the speakers that can do that, and make sure their message is consistent with releases from the CDC and state/local health agencies. • Plan ahead and develop messages that allow the community (and your ED staff) to understand you are ahead of the planning curve. • In communities with multiple EDs, work collaboratively with other ED leaders to develop an infection control response that is timely, effective, and consistent. When the next case of food poisoning, meningococcus, or tuberculosis generates media interest, have all the ED leaders release consistent statements (or appear at a joint press conference) about how each is applying the same management principles and sharing information with others. For the ED leader, the lessons can be clear: Take advantage of media interest in health topics to build the health care and community relationships needed to manage big and small emergency care issues. |
Learn differentiation steps for H1N1 During the recent outbreak of the H1N1 virus, some ED staff members had difficulties in differentiating H1N1 from other sources of respiratory illness, notes James J. Augustine, MD, FACEP, director of clinical operations at Emergency Medicine Physicians, an emergency physician partnership group in Canton, OH, and a member of the emerging diseases committee of the International Association of Fire Chiefs in Fairfax, VA. Here is what he recommends for differentiation of the disease: "Follow the CDC guides, and get any available guidance from the local public health agency. A combination of Influenza A testing plus an appropriate set of clinical symptoms results in excellent treatment decisions for patients — even without specific testing for H1N1," he says. (Editor's note: For more information, go to the CDC H1N1 web site, www.cdc.gov/H1N1FLU. On the left-hand side, click on "Info for Specific Groups." Next, click on "clinicians.") |
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