Fascinating article on handling pandemic influenza

[VAgirl]

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http://www.sacbee.com/111/v-print/story/753359.html

The article describes California's plan to handle hospital surge capacity in case of an avian influenza pandemic. So interesting! The actual plan is nearly 2,000 pages long, and can be accessed from the CA Dept of Public Health (http://www.cdph.ca.gov/Pages/default.aspx). I haven't read that one yet(😉), but this article is really interesting. Amazing to see governments (or at least one) within the US taking a hardline, practical approach to preparedness.

 

[hoodle]

That is really interesting - thanks, VAgirl! I'm impressed by the honesty and preparedness. I'm somewhat surprised, though, at the tone of horror given to to idea of a veterinarian suturing a cut or repairing a broken leg - I'd feel much more comfortable with the average licensed vet treating me or my family in an emergency than the average unlicensed or retired physician! That said, I agree that in an emergency, anyone with medical training should be authorized to give aid. Why stand on ceremony when lives are at stake!

 

[TCVM808]

"In times when there is nobody else, getting someone like a vet to help out is better than not treating a patient," Dauner said.

Haha, ouch! Can't get no respect...😉

"Everybody will have to think differently," Dauner said. "Radio, TV and police will direct patients where to go. People will be herded like cats."

Sounded like a good plan until that analogy....😛

No, but really, very thought-provoking article. Here's to hoping California leads by example in this case! Thanks for sharing the article with us, VAgirl.

 

[nyanko]

Good find. But this means that when we're vets we may have to touch icky humans in an emergency ewww! 😀

In seriousness, I'm glad that CA has something in place like this. Without proper preparedness, health care during an epidemic like that would suffer so much during an adaptation period before everyone got their stuff straight. A look into what they would encourage is really fascinating, thanks for posting it. Maybe I'll read over the 2,000 page plan over my morning coffee tomorrow. 😉

 

[banditalfi]

A few initial thoughts and then I'll go back and read people's comments:

"...animal doctors could stitch up the human wounded and set their broken bones." Strangely enough there's a word for "animal doctor" and it's "vet." But pretty cool. That being said, I'm considering going into disaster relief as a vet so I don't know how I would feel about (perhaps?) being forced into treating people. I'm not saying I wouldn't want to, I'm just not sure how it would pan out...

"The guidelines say California's strict nurse-patient ratios can be ignored, and nurses can be assigned to jobs for which they have no experience." I'm not sure how great this is... my mother is an RN and her first job was the graveyard shift in the ICU which she describes as absolutely horrible. There was no supervisor and she didn't know what half the medications were for (fresh out of nursing school and didn't encounter them often) and generally felt overwhelmed. She said that she had been taught to never give meds unless you know what they do, so she was doing treatments, didn't know what a med was and looked it up at the end... turns out it was the woman's release drug from chemo... my mom's still pretty upset about that one. Anyway, just saying it's definitely not the best situation, but I understand why they would have to do it, I would just hope they would make an effort to place nurses where they are most comfortable.

"A hospital janitor, for example, could get an emergency credential to stitch up wounds or start intravenous lines if that janitor had experience as a military medic." Stragely enough I don't really have a problem with this... start and IV, sew up the wound, put them on antibiotics and throw them on their merry way...

And my thought on the first line: "Older, sicker patients could be allowed to die in order to save the lives of patients more likely to survive a massive disaster, bioterror attack or influenza pandemic in California." My initial thought goes to the flu of 1918 where the most healthy individuals were the ones who died because it wreaked havoc on a strong immune system... what if the whole premise is just wrong?

 

[hoodle]

And my thought on the first line: "Older, sicker patients could be allowed to die in order to save the lives of patients more likely to survive a massive disaster, bioterror attack or influenza pandemic in California." My initial thought goes to the flu of 1918 where the most healthy individuals were the ones who died because it wreaked havoc on a strong immune system... what if the whole premise is just wrong?

Interesting point, my hope is that there would be relatively quick epidemiological surveys meant to corroborate and modify the disaster plan. maybe those details are in the 2000 page document? 🙄 I think the basic idea that in most cases, those with prexisting issues, the elderly, and the very young are almost always going to have the least positive prognosis... and I agree that as a baseline, that's a good place to start. but 👍 for thinking about possible alteratives to that paradigm...

 

[mistifical]

And my thought on the first line: "Older, sicker patients could be allowed to die in order to save the lives of patients more likely to survive a massive disaster, bioterror attack or influenza pandemic in California." My initial thought goes to the flu of 1918 where the most healthy individuals were the ones who died because it wreaked havoc on a strong immune system... what if the whole premise is just wrong?

Of course my initial reaction to this first part was... "oh! of course! younger healthier people can reproduce and keep the species alive!" Oh, evolution/natural selection/dr j, how I love you.

 

[Electrophile]

Haha, ouch! Can't get no respect...😉

Sounded like a good plan until that analogy....😛

No, but really, very thought-provoking article. Here's to hoping California leads by example in this case! Thanks for sharing the article with us, VAgirl.

Yeah, kinda like this:

http://www.youtube.com/watch?v=Pk7yqlTMvp8



All things considered, I'd probably rather have the average community practice vet who does routine surgeries daily do an emergency surgery on me rather than a family practice doctor who hasn't really wielded a scalpel since their internship, if that!

Actually, it's been pretty cool lately in class. We've had both our anatomy professor and our endocrinology professor really stress to us to look at ourselves as future veterinary medical doctors to the public, not just someone who gives shots and checkups since that's all many people ever see of the profession. We're having a conference of sorts next weekend inviting a bunch of law and policy makers to the vet school to discuss how we can reverse the trend of huge increases in tuition, whereas our salaries don't match up. Our VBMA president sent us an e-mail saying that by 2017, we'll have to make like 217K a year to be able to pay off our loans! 😱 I was going to attend anyways, but that's a pretty strong incentive to have our voices heard!

 

[TCVM808]

Yeah, kinda like this:

http://www.youtube.com/watch?v=Pk7yqlTMvp8

Oh yes, one of the (if not THE) best Super Bowl commercials of all time!! 😀

 

[greenie53]

that was hilarious

 

[VAgirl]

Hmm...so back on topic... 🙂

This is an excerpt from the Surge Standards and Guidelines, Volume II, Alternate Care Sites:

"Special Considerations for Pharmacists (continued)

Furnishing Medications without a Prescription
• During a healthcare surge, there may be limited time to receive a prescription from a physician.
• Business and Professions Code Section 4062(a) states that a pharmacist may, in good faith, furnish a dangerous drug or dangerous device in reasonable quantities without a prescription during a federal, State or local emergency to further the health and safety of the public."​

Now granted we're not pharmacists or pharmacy students, but I think this is interesting since, to me, it's what is at the basis of this whole discussion/planning--the fact that in an emergency situation like a pandemic, the time and resources needed to function up to the standards of care that we expect in our medical system are simply not available. And I pulled this excerpt out because it is currently believed that getting patients on Tamiflu (currently accepted to be the most effective antiviral Tx) within 48hrs of symptom onset is critical in increasing chances of survival. Odds of survival decrease dramatically after that. So getting drugs without a doctor's prescription could be critical. However, the supply of drugs is going to be severely limited, so how does the pharmacist determine who is sick enough to warrant the antiviral? Or perhaps more to the point, who is within the window of time when the drug will do the most good? Can a pharmacist make that kind of call? Are they trained to? If not, do volunteer pharmacists need to be receiving this sort of training to make better determinations as to how to allocate the limited antiviral supply? Because as we can see above, they will have the authority to do so without an Rx in this type of situation.​

Just one ethical topic out of the many that this type of planning brings up and that I find fascinating. 😀 (Well, in the academic way. If this was actually happening, it would be more along the lines of terrifying.)​