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Ability of Regional Hospitals to Meet Projected Avian Flu Pandemic Surge Capacity Requirements

Published online by Cambridge University Press:  28 June 2012

Raymond P. Ten Eyck
Raymond P. Ten Eyck*
Affiliation:
Center for Global Health Systems, Management, and Policy, Department of Community Medicine, Wright State University Boonshoft School of Medicine, Kettering, Ohio, USA
*
Center for Global Health Systems, Management, and Policy Department of Community Medicine, Wright State University Boonshoft School of Medicine, 3139 Research Blvd. #205 Kettering, Ohio 45420, USA E-mail: [email protected]
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Abstract

Introduction:

Hospital surge capacity is a crucial part of community disaster preparedness planning, which focuses on the requirements for additional beds, equipment, personnel, and special capabilities.The scope and urgency of these requirements must be balanced with a practical approach addressing cost and space concerns. Renewed concerns for infectious disease threats, particularly from a potential avian flu pandemic perspective, have emphasized the need to be prepared for a prolonged surge that could last six to eight weeks.

Null Hypothesis:

The surge capacity that realistically would be generated by the cumulative Greater Dayton Area Hospital Association (GDAHA) plan is sufficient to meet the demands of an avian influenza pandemic as predicted by the [US] Centers for Disease Control and Prevention (CDC) models.

Methods:

Using a standardized data form, surge response plans for each hospital in the GDAHA were assessed.The cumulative results were compared to the demand projected for an avian influenza pandemic using the CDC's FluAid and FluSurge models.

Results:

The cumulative GDAHA capacity is sufficient to meet the projected demand for bed space, intensive care unit beds, ventilators, morgue space, and initial personal protective equipment (PPE) use. There is a shortage of negative pressure rooms, some basic equipment, and neuraminidase inhibitors. Many facilities lack a complete set of written surge policies, including screening plans to segregate contaminated patients and staff prior to entering the hospital. Few hospitals have agreements with nursing homes or home healthcare agencies to provide care for patients discharged in order to clear surge beds. If some of the assumptions in the CDC's models are changed to match the morbidity and mortality rates reported from the 1918 pandemic, the surge capacity of GDAHA facilities would not meet the projected demand.

Conclusions:

The GDAHA hospitals should test their regional distributors' ability to resupply PPE for multiple facilities simultaneously. Facilities should retrofit current air exchange systems to increase the number of potential negative pressure rooms and include such designs in all future construction. Neuraminidase inhibitor supplies should be increased to provide treatment for healthcare workers exposed in the course of their duties. Each hospital should have a complete set of policies to address the special considerations for a prolonged surge. Additional capacity is required to meet the predicted demands of a threat similar to the 1918 pandemic.

Keywords

avian influenzapandemicregional hospitalssurge capacity
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 23 , Issue 2 , April 2008 , pp. 103 - 112
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

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References

1. Anderson, M: Avian, flu: WHO prepares for the worst. CMAJ 2004;170(5):777.Google Scholar
2. Borgundvaag, B, Ovens, H, Goldman, B, et al. : SARS outbreak in the Greater Toronto Area: The emergency department experience. JAMC 2004;171(11): 1342–1344.Google Scholar
3. Lau, JT, Yang, X, Leung, P, et al. : SARS in three categories of hospital workers, Hong Kong. Emerg Infect Dis 2004;10(8):1399–1404.Google Scholar
4. Lau, JT, Fung, KS, Wong, TW, et al. : SARS transmission among hospital workers in Hong Kong. Emerg Infect Dis 2004;10(2):280–286.Google Scholar
5. Tsai, MC, Arnold, JL, Chuang, CC, et al. : Impact of an outbreak of severe acute respiratory syndrome on a hospital in Taiwan, ROC. Emerg Med J 2004;21:311–316.Google Scholar
6. Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO. Available at http://www.who.int/csr/disease/avian_influn za/country/cases_table_2006_09_19. Accessed 22 Sept 2006.Google Scholar
7. Kurtz, J, Manvell, RJ, Banks, J: Avian influenza virus isolated from a woman with conjunctivitis. Lancet 1996;348:901–902.Google Scholar
8. Parry, J: WHO investigates possible human to human transmission of avian flu. BMJ 2004;328:308.Google Scholar
9. Normile, D: Vietnam battles bird flu and critics. Science 2005;309:368–373.Google Scholar
10. Hoard, M, Homer, J, Manley, W, et al. : Systems modeling in support of evidencebased disaster planning for rural areas. Int J Hyg Environ Health 2005;208:117–125.Google Scholar
11. Flowers, LK, Mothershead, JL, Blackwell, TH: Bioterrorism preparedness II: The community and emergency medical services systems. Emerg Med Clin N Amer 2002;20:457–476.CrossRefGoogle ScholarPubMed
12. Greenberg, MI, Hendrickson, RG: CIMERC: Drexel University Emergency Department Terrorism Preparedness Consensus Panel: Report of the CIMERC/Drexel University Emergency Preparedness Consensus Panel. Acad Emerg Med 2003;10:783–788.Google Scholar
13. Capua, I, Alexander, D: Avian influenza and human health. Acta Tropica 2002;83:1–6.CrossRefGoogle ScholarPubMed
14. Barry, JM. The Great Influenza. New York: Penguin Group, 2005, pp 107–115.Google Scholar
15. Beare, AS, Webster, RG: Replication of avian influenza viruses in humans. Arch Virol 1991;119:37–42.CrossRefGoogle ScholarPubMed
16. Peiris, M, Yam, WC, Chan, KH, et al. : Influenza A H9N2: Aspects of laboratory diagnosis. J Clin Microbiol 1999;37:3426–3427.Google Scholar
17. Shortridge, KF, Zhou, NN, Guan, Y, et al. : Characterization of avian H5N1 influenza viruses from poultry in Hong Kong. Virology 1998;252:331–342.Google Scholar
18. Meltzer, MI, Shoemaker, H, Kownaski, M: FluAid 2.0: A manual to aid state and local level public health officials plan, prepare, and practice for the next influenza pandemic.Available at http://www2a.cdc.gov/od/fluaid/.Accessed 15 Nov 2005.Google Scholar
19. Zhang, X, Meltzer, MI, Wortley, P: FluSurge 2.0: A manual to assist state and local public health officials and hospital administrators in estimating the impact of an influenza pandemic on hospital surge capacity (Beta test version). Available at http://www.cdc.gov/flu/pdf/FluSurge2.0_Manual_060705.pdf. Accessed 15 Nov 2005.Google Scholar
20. American Fact Finder; US Census Bureau Website.Available at http://factfind er.census.gov/home/saff/main.html?_lang=en.Accessed 15 Nov 2005.Google Scholar
21. Barry, JM: The Great Influenza. New York: Penguin Group. 2005, p 238.Google Scholar
22. Vortran Medical Technology 1, Inc: Vortran Automatic Resuscitator User Guide. Available at http://www.vortran.com. Accessed 16 May 2006.Google Scholar
23. Mead, K, Johnson, D: An evaluation of portable high-efficiency particulate air filtration for expedient patient isolation in epidemic and emergency response. Ann Emerg Med 2004;44:635–645.CrossRefGoogle ScholarPubMed
24. Rosenbaum, RA, Benyo, JS, O'Connor, RE, et al. : Use of a portable forced air system to convert existing hospital space into a mass casualty isolation area. Ann Emerg Med 2004;44:626–634.Google Scholar
25. Reid, AH, Fanning, TG, Janczewski, TA, et al. : Characterization of the 1918 “Spanish” influenza virus neuraminidase gene. Proc Natl Acad Sci USA 2000;97:6785–6790.Google Scholar
26. Hogan, DE, Waeckerle, JF, Dire, DJ, et al. : Emergency department impact of the Oklahoma City bombing. Ann Emerg Med 1999;34(2):160–167.Google Scholar
27. Cone, DC, Weir, SC, Bogucki, S: Convergent volunteerism. Ann Emerg Med 2003;41(4):457–462.CrossRefGoogle ScholarPubMed
28. Romano, M: Medical personnel respond: Physicians across the nation eager to volunteer. Mod Health 2001;31(38):24.Google Scholar
29. Barry, JM. The Great Influenza. New York: Penguin Group. 2005, pp 175–209.Google Scholar
30. WHO interim guidelines on clinical management of humans infected by influenza A (H5N1). Available at http://www.who.int/csr/disease/avian_influenza/guide lines/clinicalmanage/en/.Accessed 06 December 2005.Google Scholar
31. Qureshi, K, Gershon, RM, Sherman, MF, et al. : Health care workers' ability and willingness to report to duty during catastrophic disasters. J Urban Health 2005;82(3):378–388.Google Scholar
32. Shapira, Y, Marganitt, B, Roziner, I, et al. : Willingness of staff to report to their hospital duties following an unconventional missile attack: A state-wide survey. Isr J Med Sci 1991;27:704–711.Google Scholar
33. Sibbeld, B: Right to refuse work becomes another SARS issue. CMAJ 2003;169(2):141.Google Scholar
34. Reid, L: Diminishing returns? Risk and the duty to care in the SARS epidemic. Bioethics 2005;19(4):348–361.Google Scholar
35. Influenza, A (H5N1): WHO interim infection control guidelines for health care facilities.Available at http://www.wpro.who.int/NR/rdonlyres/B045DC3C-A776-4455-8A6A-B70F5269454F/0/Guidelines_for_health_care_facilities_10Mar.pdf. Accessed 06 December 2005.Google Scholar
36. Pandemic Flu Website. Antiviral–State Allocations. http://www.pan demicflu.gov/state/antivirals.html. Accessed 26 March 2008.Google Scholar
37. Pandemic Flu Website–Federal Response Stages. http://www.avianflu.gov/ plan/federal/fedresponsestages.html. Accessed 10 October 2007.Google Scholar
38. Bright, RA, Medina, M, Xu, X, et al. : Incidence of adamantine resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: A cause for concern. Lancet 2005;366:1175–1181.Google Scholar
39. Moscona, A:Neuraminidase inhibitors for influenza. N Engl J Med 2005;353: 1363–1373.CrossRefGoogle ScholarPubMed
40. Hick, JL, Hanfling, D, Burstein, JL, et al. : Health care facility and community strategies for patient surge care capacity. Ann Emerg Med 2004;44(3):253–261.CrossRefGoogle Scholar