Hospital Care for Swine Flu

Photo courtesy of Robert Simmons

Several years ago, in 2006, Dr. Dan Hanfling, director of emergency management and disaster medicine at the Inova Health System in Falls Church, Virginia, said that, in a pandemic, hospitals in the Washington, D.C., area would be flooded with patients with nowhere to put them.

"There are going to be many, many people coming to the hospital because they are worried they may have been exposed. If there was just a 10 percent infection rate, that would mean 500,000 sick people in the Washington, D.C., area, Hanfling calculated.

Some models assume that 20 percent of these people would need to be treated in hospitals. "We are talking about finding 100,000 places," Hanfling said. "We only have 7,800 staffed beds. We'll still have heart attacks. We'll still have strokes. We'll still have babies to deliver."

Triage – Who Gets Treated First?

Triage is the system that hospital emergency rooms and military battlefield hospitals use--to decide whom to treat first.

Triage is usually based on urgency or chance for survival. Hospital staff will be forced to make very difficult decisions about who has access to medical equipment and hospital care.

They will choose government employees, military personnel and health care workers first—that’s actually part of the US government protocol.

Hospital Staff

One survey of hospital workers showed that only 66 percent of health care workers would show up for work if they thought patients might infect them.

Photo courtesy of Sarah McD3s

Some will simply stay home because their children's schools are closed. The faithful few who continue to work will become overtired and overworked.

The medical staff at hospitals will start to get the H1N1 swine flu themselves, they will have sick family members, or they will simply refuse to go to work (or just not answer their phones because they know that they are being called to come to work).

This is not inconceivable, as healthcare workers are routinely required to stay at work until their replacement arrives. I’ve seen many occasions when nurses and aides were forced to remain at work over a 2-3 day period because of a snowstorm that prevented others from coming to work.

Those workers who go to work and end up working double or triple shifts will be more susceptible to getting sick and they will make mistakes because they are overwhelmed and tired.

Hospital care will do downhill rapidly, when hospital workers are unhappy with their working conditions and overworked!

Hospitals Will Run Out of Beds

More difficult decisions will have to be made. Will an old, frail person be bumped from their ventilator to make room for a younger person who might have a better chance to live?

Mobile healthcare unit in Mexico City, April 2, 2009
Photo courtesy of PBS NewsHour with Jim Lehrer

Or a government employee or politician over a factory worker? Treatment and hospital care will no longer be given on a first come, first served basis.

At some point, you won’t have a choice about going to a hospital. The hospital will no longer accept patients—any patients.

And it won't matter how good your insurance is—or how much money you have! The beds will fill rapidly and there will no longer be any room.

You may be able to go to a makeshift hospital in a school (Schools will close when the pandemic comes). There will be rows of patients who also need care and there will be a few brave volunteers from the community who will try to take care of the patients, even though they may have no healthcare experience.

The makeshift hospitals won’t have any more flu medicines or supplies than the hospitals.

Hospital Supplies

At some point, the ventilator that you need--will no longer be available, as intensive care equipment available in hospitals will be used rather quickly. Hospitals will start to run out of essential supplies.

Hospitals operate on a “Just in Time” basis and critical supplies like bed pads, medicines, disposable plates and cups, needles, respirator masks and latex gloves are quickly used. (I’ve seen chaos develop in a nursing home—when it ran out of bed pads!)

Replacement supplies will be slow in coming or they will not come at all. Employees of companies and truckers will stay home, too. Some health care workers will refuse to work if they don’t have the appropriate supplies to protect themselves.

Your best chance for survival is to stay at home, away from the sick crowds and declining hospital care. If you are prepared, you can give (or get) better in home care than you would find in a makeshift hospital.

But the key to survival is that you must be ready. Prepare now so that, if you need to treat someone at home, because there is no available hospital care, you will be ready!

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