| Set up fully, it can house 100 beds. It can also be set up in four 25 bed sections for separate use, and we've deployed one of those sections to an area near to Danbury Hospital, adjacent to Bethel Health Care, a nursing home in the town of Bethel, CT. This local storage, use and deployment is the first time in the state the MFH has been set up this way.
Knowing that we had access to this facility, local health and community leaders had an idea. Having been educated over the past year about the possibility of a severe pandemic, and the inevitability of some sort of event, area hospitals, nursing homes, businesses and health care groups decided to band together and try something.
In the event of a pandemic, the hospital would be overflowing with patients. To alleviate some of the bed crunch, the area nursing homes and extended care facilities would pool their available beds, accept transfers from the hospital to free up bed space, and utilize empty beds remaining to act as a 23 hour alternate care facility for flu patients. The Ottilie W. Lundgren Memorial Field Hospital would be set up adjacent to an area nursing home (not the hospital), and the parking garage would be used as a drive-by (stay in your car) flu clinic (see lugon's 'austere' care post.)
Area residents would be told to stay home, and care instructions via www.getpandemicready.org and American Red Cross (and other home care sites - see Into The Woods' excellent resource list) would be offered on line. If people felt ill, had fever >103, or lower fever for >5 days, had respiratory difficulty such as cough or shortness of breath, or were not urinating for 12 hours or more, or felt they could no longer stay home and they wanted to get checked out, they could drive over to the drive-by flu clinic. Area residents would be encouraged to do this, rather than go to the overwhelmed hospitals.
Staffing would be on a volunteer basis from area health care organizations, including nursing homes and hospitals.
Those that were well (green) would be given a home care packet (American Red Cross and getpandemicready.org). Those that were well but scared or in need would be moved to the social service tent, same info, more resources including psych counseling (blue, for this exercise). Those that needed hydration (IV, nasogastric or by mouth) would move to the MFH for a few hours (yellow), and sent home with home care instructions. Those that were not ready to go home would go into the nursing home for 23 hour observation (amber). Those with respiratory difficulty would be transported to the hospital (red). Those that died would be processed (black).
As a first step in implementing the testing of this scheme, we wrote and implemented an overarching scenario:
What day/week are we?
Day 11 of H5N1 outbreak in the US. There are 100 suspected cases (and half of those are confirmed cases) of H5N1 in CT and 1100 confirmed cases overall in the US. Other states are harder hit, some not yet hit at all. It's also seasonal flu season.
What do we know about the virus?
It's influenza A, H5N1 and susceptible to tamiflu/oseltamivir, resistant to adamantanes. It's a clade 2.1 variant from Indonesia, and the pre-pandemic vaccine we have does not match.
What's the WHO phase?
We are now at WHO Phase 6 (early USG stage 5). This is efficient and sustained human to human transmission, but we are early in the acceleration phase.
What's the case fatality rate or other info that lets us know if it's a category 1,2,3,4 or 5 pandemic?
The case fatality rate is 7%, suggesting a category 5 pandemic In fact, the above is an actual exercise, and it started yesterday with the deployment and standing up of the MFH. Today was the press conference informing local media about the event (more about that tomorrow, with a news link), with state officials in attendance. Tomorrow will be a tabletop exercise with area health care leaders and the state DPH, including the state regional epi team. Saturday will be a run-through using volunteers as patients, volunteers as staff, and volunteers as evaluators of the exercise.
Our purpose in putting this together is to utilize the MFH, practice its local deployment, use its facilities to triage and plan surge in a pandemic, and coordinate with area organizations and the state for communication, triage and health care.
This is the first time such a panflu exercise has been done locally or on this scale as a live exercise and MFH deployment, in the state. For all we know, it's the first time it's been exercised in the country (although we must acknowledge the superb work done by Pierce County, WA in writing the Alternate facility triage guidelines that we used and adapted).
More tomorrow and through the weekend as we see how well or how poorly such an idea would work. The exercise, however, is already a success; diverse area organizations that have never worked together are now working as one in order to brainstorm about how to deal with a severe influenza pandemic, one with a worse CFR than 1918. It also gives us a chance to practice surge but emphasize home care. And that is an idea whose time has come. |
