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So here's an interesting way to look at things... rather than look to Chicken Little ('the sky is falling!') as the model of how the potential threat of pandemic flu should be approached, let's look at a more realistic model of how the world works.

Stephen Flynn, former Coast Guard commander and author of The Edge of Disaster, says that the United States medical system is unprepared to handle a catastrophic emergency such as a flu pandemic or a major terrorist attack.

The problem, Flynn says, is that hospitals have been trying to cut costs.

"The medical community has been moving in the direction of much of our economy," he says, "which is wringing out the extra capacity in order to essentially focus on the bottom line."

Given that baseline reality, and the likelihood that the current federal budget will not assist localities in coping better, any new or extraordinary stress on the system will not be simply absorbed.

Each year, more than 300,000 people are treated in U.S. hospitals for the flu. The common flu is dangerous; more than 30,000 Americans die from it every year. But Flynn is even more concerned by the prospect of pandemic flu, such as the outbreak that occurred in 1918.

Flynn estimates that a pandemic flu outbreak today would result in 80 million infected Americans. If the death rate were similar to that of the 1918 flu, then a current flu pandemic could result in 800,000 deaths in the United States.

But the 1918 flu is not worst case, and Flynn's estimate underplays the reality.

Why does it underestimate? Because 675,000 Americans died in 1918 when the US was a third of the population it is now. Other estimates of a 1918 style pandemic give upwards of 1.7 million deaths (it does no good to have modern medical care if you can't get in to the hospital). This former CDC head says 3 million. whatever the number, it's a reminder of the shape our health care system is currently in.

Oh, and by the way, the 1918 virus is not the worst case scenario. The current H5N1 virus going pandemic at its current case fatality rate of over 50% at attack rates of 35% is. A third of the world is ill and half of them die. This is a proposition written in serious peer-reviewed medical journals (see What Hospitals Should Do to Prepare for an Influenza Pandemic and The Prospect of Using Alternative Medical Care Facilities in an Influenza Pandemic, for examples). To utter such a thing is to be accused of 'fearmongering', of being a Chicken Little, but this is the reality... it's a threat that's being discussed all over the medical literature, and if it is upsetting to hear, nonetheless, it is merely a reflection of how professionals react to the knowledge of what's happening today in SE Asia (Indonesia) and Africa (Egypt).

Does that mean we'll have a pandemic this month or this year? I didn't say that; the reason I didn't is because no one knows when the next flu pandemic will be, or whether H5N1 will be the agent, or whether it'll have a high case fatality rate like 1918 or (worse) the current H5N1. That's simply unknowable at this point, despite the hard work done by flu experts all over the world in trying to figure out the answer to that one.

Given the uncertainty, what is the best thing to do? Prepare for it in advance, say the experts.

The former director of the U.S. Centers for Disease Control and Prevention predicts a pandemic flu that will cause a tsunami-like "disruption of goods and services" so intense it sweeps away the "staples of modern life."

Dr. Jeffrey Koplan, who headed the CDC during the SARS outbreak of 2002-03, on Thursday urged Connecticut's college administrators to draft their own plans for dealing with pandemics, rather than try to graft some other agency's ideas onto their institutions.

"It has to be your own," he said. It also must be dynamic and revised regularly.

Colleges and universities must consider factors such as whether they have on-campus infirmaries and whether students live on-campus, Koplan told the 300 academic administrators and health officials at the forum, "A Case Study for Campus Pandemic Flu Planning." It was organized by Yale University and held at Southern Connecticut State University.

And even if it's a different kind of emergency, like an ice storm or tornado, what happens if your neighbor prepares and you don't? In terms of pandemic:

Yale continues to wrestle with what incentives to put in place to have key personnel continue to work in the face of a life-threatening disease, she said. The ethical issues are who gets anti-viral medication and with whom do you share them?

Koplan called it the "little red hen syndrome," where one institution prepares, but another doesn’t and then wants resources. "What do you do? This is tough stuff," he said.

The Little Red Hen Syndrome. The Grasshopper and the Ants. Truly, everything you need to know you learned in first grade. So, consider what you can do that is sensible, affordable and acommodates your budget (and also fits in where you live). And while you consider yourselves and your families, others are considering infrastructure and the schools. in fact, reconsider what you do for any emergency. Chances are, you are not doing enough to help protect you and your family for when the unanticipated hits.

This public service message was brought to you by the Little Red Hen.

Originally posted to Daily Kos on Sun Feb 25, 2007 at 08:05 AM PST.

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Comment Preferences

  •  The Western World (9+ / 0-)

    has sailed through post-WWII times with such ease that, as always happens, when something really nasty comes down the pipe, it is not going to be pretty...

    "Uncle Fredo's gone fishing, son...yeah, that's it..."

    by TheManWithNoPoint on Sun Feb 25, 2007 at 08:07:01 AM PST

  •  I wonder how many recognized experts (16+ / 0-)

    have to say, "hey, folks, this threat is real" before people start to catch on that yep, unlikely as it seems, this is a possibility, and that uncertainty has to be dealt with.

    part of the solution has to be to take a broader look at our heath care system. We intend to do so at Yearly Kos. But in the meantime, think on how you might approach this at the family and personal level.

    The feds recommend two weeks of food and water. Those exploring the issue recommend more. But whatever you do and can afford, think about it.

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

    by Greg Dworkin on Sun Feb 25, 2007 at 08:09:52 AM PST

  •  Thanks for making my day, DFCT - (3+ / 0-)
    Recommended by:
    Shadan7, Winnie, willers

    NOT!

    Out here in earthquake country, it pays to have everything in order for a week or two on your own. Your story, though, led me to believe my emergency kit might be missing one potentially important item:

    A Remington pump-action 12-gauge, with a coupla boxes of shells.

    Actually, maybe more Visqueen and duct tape, to protect my family from the perfect cytokine storm.

    Yikes.

    As nightfall does not come all at once, neither does oppression. - Justice William O. Douglas

    by occams hatchet on Sun Feb 25, 2007 at 08:14:46 AM PST

  •  "High Census" alert (6+ / 0-)

    Every year the regular flu, plus other seasonal influences, puts our hospital on "High Census" alert and we all run around trying to figure out what to do with the 10-15 patients we don't have beds for.

    I can hardly (NOT!!) wait for a major pandemic of even a slightly more virulent strain...

    •  that's the reality (4+ / 0-)

      amongst the attention-getting stuff, that reality should not be lost.

      preparations can mitigate the worst, but only if planned in advance.

      The message here is not: panic or: we're doomed, its: start planning, and maybe consider reviewing what you have in your home. And participate when planning goes local.

      oh, and support your local hospital and public health department. You never know when it'll be needed.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 25, 2007 at 08:28:54 AM PST

      [ Parent ]

    •  It Won't Be So Much the Actual Curse (2+ / 0-)
      Recommended by:
      DaleA, Winnie

      but the resultant ugly and self-preservatory actions of mankind in response to this that will hurt...

      I believe that the greatest test of Western civilization is not terrorism, but the changing weather patterns and new virulent bacteria/viruses that will determine how and when we meet our ends...

      "Uncle Fredo's gone fishing, son...yeah, that's it..."

      by TheManWithNoPoint on Sun Feb 25, 2007 at 08:33:38 AM PST

      [ Parent ]

  •  Having worked for 16+ years (11+ / 0-)

    in U.S. hospitals in the capacity of Emergency Manager... I can attest to the FACT that Disaster Preparedness is not much more than a written plan... Little to NO money is allocated to the preparation for disaster.

  •  Thanks Dem for pointing out the obvious... (8+ / 0-)

    I'm tired of people thinking the CW is that a pandemic would be No Big Deal.  The worst case scenario is indeed what Dem says, 1/6th of the world's populations wiped out.  That's 1 billion people folks.

    Now, I don't know if that means 50 million Americans, probably a good percentage of that 1 billion would come from developing nations that have little to no resources.  But nonetheless this fiction of worst case scenario in the US being only a few 100K people dead is a gross underestimate.

    Thanks for putting things into perspective Dem.

    BTW, will there be a pandemic flu panel at Ykos?

    People should not be afraid of their governments. Governments should be afraid of their people.

    by viget on Sun Feb 25, 2007 at 08:27:57 AM PST

    •  I don't know yet - tight schedule (5+ / 0-)
      Recommended by:
      Athena, RunawayRose, Shadan7, cookiebear, viget

      but there'll at least be a journal submission for the Journal of Netroots Ideas.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 25, 2007 at 08:30:22 AM PST

      [ Parent ]

    •  US gov't says municipalities should plan (0+ / 0-)

      for 30% getting sick, 3% needing hospitalization and .6% (six-tenths of 1%) deaths.

      Pandemic Planning Assumptions

      •  and yet, the former Director of the CDC predicts (2+ / 0-)
        Recommended by:
        splashy, willers

        a pandemic flu that will cause a tsunami-like "disruption of goods and services" so intense it sweeps away the "staples of modern life."

        Is it possible HHS is using such modest assumtions for planning because those numbers would be the limit to what they could manage and control?

        If somebody read those Planning Assumptions, and if that was all they read, they could easily get the idea that HN51 pandemic would be "no big deal."

        •  that's exactly right (2+ / 0-)
          Recommended by:
          splashy, Winnie

          yet the planning assumptions need to be adjusted. That 'lowball' estimate has a lot of people concerned.

          Still, this is the slide that went into the planning assumptions:

          Note that 1918 is a 'mild 5', and note the 'new' approach is to think of pandemics as a category 1-5 scale, similar to hurricanes.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Feb 25, 2007 at 12:42:01 PM PST

          [ Parent ]

    •  what no one will admit (1+ / 0-)
      Recommended by:
      DaleA

      is digging a grave is a bitch and a half.  In the meantime, most folks have no idea how to operate a backhoe.
      I guess we would have to resort to bonfires and weenie roasts behind the funeral parlor.

      •  Well, cremation is the best way (0+ / 0-)

        to be rid of diseases quickly and cleanly.

        And it happens I do have a backhoe and know how to use it. There's a pleasant thought. At least us rural folks will do better -- less human contact, more self-sufficient (except for the wannabes... ugh) familiar with guns (also good for hunting deer), a decent percentage with backhoes and property for burials... etc.

        Spring is coming, America... and with it, hope once again.

        by willers on Sun Feb 25, 2007 at 01:14:42 PM PST

        [ Parent ]

        •  well the MF backhoe isnt running (0+ / 0-)

          but the big Case is still running so long as we have diesel. A local poultry farmer has a crematorium for his chicken houses and he takes the carcasses out with a Bobcat. I am not sure how much of a solution cremation is given the air pollution involved.
          I don't know how many of our city cousins I would trust on a backhoe and digging a grave with a shovel is no fun at all.

          •  I think cremation's contribution to air pollution (0+ / 0-)

            is not a real concern, especially considering how much pollution just daily traffic gives off, and how necessary cremation will be in the event of a huge pandemic. Good idea about the poultry farmer's crematorium, those sorts of places may be needed.

            As for city folks... I'm pretty sure they're screwed any time something big comes along, whether it's a hurricane, pandemic or Peak Oil. Which is why I moved out here years ago to have a homestead.

            And yes, digging a grave with a shovel sucks, especially depending on your soil -- ours is heavy clay full of big rocks, and in summer you'd have better luck digging through solid concrete. I'll never forget how long it took to dig a hole for that baby fawn carcass the dog dragged home, even with the garden hose running to soften the dirt. And the woodshed... took 4 days of hard labor with picks and shovels to dig out a 4x4x10 piece of hillside for the woodshed to sit level...

            Spring is coming, America... and with it, hope once again.

            by willers on Sun Feb 25, 2007 at 04:03:14 PM PST

            [ Parent ]

            •  i guess you never had to bury a mule before (0+ / 0-)

              My grandfather broke me from feeding green corn to a mule without walking him down first to cool off after a hard's day work; my idea was a big tub of cold water and green corn.  Took me two days to get him in the ground and then the dogs dug him up........
              The kids foundered their pony years ago with green apples and by the time they finished burying her, they decided that taking a little time and doing things the right way would save a lot of time in the long run.  

              •  That's one of the big reasons (0+ / 0-)

                I DO have a backhoe, to make burying livestock easier. They don't live forever and there ain't no local rendering plants no more.

                Spring is coming, America... and with it, hope once again.

                by willers on Mon Feb 26, 2007 at 09:05:33 AM PST

                [ Parent ]

  •  Apples and Oranges (3+ / 0-)
    Recommended by:
    DaleA, Winnie, Lychee

    I have a question for the experts of which I am not one. I read all the time about the comparison to 1918 and today and although you have raised the death rate to accommodate the higher population, how much do the living conditions in the United States today compare to them in 1918? I know that in the 50's, my Grandparents who had moved from the city to a country farm still did not have running water in the house. They used LAVA soap to wash their hands and they did not contact any contagious major diseases. I can not even remember them even having a cold. My Grandfather lived to 87 and there was never a piece of fat he didn't love.

    But reflecting on the living conditions then and the hygienes we practice now in our lives, is this a true comparison?

    I got my Swine Flu shot in the 1976. It was a vary scary time as the experts were predicting an enormous amount of deaths. Unfortunately, the Swine Flu shot killed some people and had to be stopped and there was only 1 possible death reported at Ft. Dix.

    Not to downplay this very possible and once again scary prediction, how likely is it to be as major to the US as to a 3rd World Country. Will it relate once again to poverty and squalor living conditions?
    How can it be controlled? You can not believe how many reasonable and professional people I know who have now armed them self for this panademic.

    Wishing our lives away for '08

    by BarnBabe on Sun Feb 25, 2007 at 08:36:44 AM PST

    •  excellent questions (8+ / 0-)

      as to 1918, people were far more self sufficient, and the JIT economy far less dependent on long distance parts to function. To get an idea of that, see: business continuity page and quick example. Or, take the food distribution service industry.

      And although there is more modern medicine, with less than a million hospital beds, there's no easy answer there. See the link I provided in the story to alternative health care facilities. That's the kind of planning that needs to be done.

      The real key is vaccine. that's the power tool in the toolbox. If we have enough time, R&D might help out with a pre-pandemic vaccine. But we are years away from having capacity and knowledge to vaccinate the world.

      if it hits before vaccine is ready, we're screwed.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 25, 2007 at 08:50:46 AM PST

      [ Parent ]

      •  Vaccine production and research (3+ / 0-)
        Recommended by:
        splashy, Winnie, willers

        has become too politicized.

        In the 1950s, I was a Polio Pioneer.  They tested the vaccine on school children, because there was a real urgency to put a stop to this disease.

        Now, it seems to be more a question of drug company profits and liability, not the public good.

    •  Person-to-person transmission of influenza (8+ / 0-)

      is very efficient. It isn't prevented by handwashing, although that helps alot. It's spread by airborne droplets-cough, sneeze, etc. Imagine the science fiction scenarios; everyone walking around in gloves and surgical masks. (By the way, do we have enough?) With decent health resources, we can probably save a high percentage, but, as the diary shows, our resources are already stretched.

      We are men of action; lies do not become us.

      by ER Doc on Sun Feb 25, 2007 at 09:06:24 AM PST

      [ Parent ]

      •  thanks ER Doc (3+ / 0-)
        Recommended by:
        splashy, Winnie, ER Doc

        ACEP (ER professional society) is clear that EDs cannot handle pandemic loads. A goal would be to use fever clinics and alternative care to protect the EDs.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Feb 25, 2007 at 10:23:05 AM PST

        [ Parent ]

      •  good response (1+ / 0-)
        Recommended by:
        ER Doc

        I am also concerned about "collateral injuries" such as people injured by events that do not ordinarily occur.  While assaults and robberies may not immediately increase, as rapid response and regular responders either become infected or simply drop from exhaustion, we will find the second rank of responders very thin in rural areas.
        Any pandemic will take out the elderly and young first but simply dealing with the volume will overload those communities already running short of resonders (ref. the discussion a few day earlier on the number of NG who are firemen, cops, EMTs or just strong young people able to help, who are in Iraq a/la Katrina)  

        •  Who's most at risk (1+ / 0-)
          Recommended by:
          splashy

          depends on the virus.

          For example, 18-40 year olds died in disproportionate numbers during the flu of 1918. Their healthy immune systems produced an over-exuberant response to the influenza virus that lead to the host's death. Similarly, the Avian flu influenza (H5N1) is mostly killing children (50%).

          However, it is the model that the health department is  using.

      •  I recently attended a talk about the pandemic flu (0+ / 0-)

        by public health epidemiologist who said that the dominant thinking still is that influenza is spread by droplets (=surgical mask okay), but they haven't ruled out airborne transmission (=N95 respirators required).

        She said that one of the lessons that they learned from SARS was that transmission of SARS to healthcare workers occurred during aerosol generating procedure. They assumed that surgical masks would provide sufficient protection but found out that they were wrong, so now they are recommending healthcare workers to wear N95 respirators during aerosol generating procedures.

    •  Don't rely on the "hygiene" we practice now. (7+ / 0-)

      **Warning: disgusting post following**

      I realize some of this may sound snide-- it's not meant to be. I haven't had a lot of sleep this week. :)

      I also just saw ERDoc's post pop up. You beat me to it, Doc. :)

      Hygiene today is a lot better than it was a hundred years ago. But too many people cough and sneeze without covering their mouths, and if someone manages to get you in the face and you can't wash your face immediately, you're going to be at risk for whatever they've got no matter how good your hygiene is.

      That sounds absolutely disgusting and paranoid, but I speak from experience. I worked at a market and was very careful to wash my hands often, not touch my face after handling items or money, etc. Yet sick customers (hey, they still needed food) would come in and not even turn away, and yes, I could feel the air from the cough on my face. I got eight colds in the space of three and a half months. I normally average 0-2.

      •  check this out... (2+ / 0-)
        Recommended by:
        splashy, Winnie
        For those who haven't seen it, here is a funny and informative video by Ben Lounsbury

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Feb 25, 2007 at 10:13:10 AM PST

        [ Parent ]

      •  I use to work in a nursing home (3+ / 0-)
        Recommended by:
        splashy, Winnie, willers

        When I came back to PA from California and left the rat race behind, I took a job at the local Nursing Home close to home. It was fulfilling and had excellent health insurance. I was in activities and there was a lot of contact with the residents. I annually received my flu shot and was careful to wash my hands. I was sick with something or other about 4 times a week. A year ago I went with a large local company and back to Accounting and luckily for me it is still 2 miles away from my home. Knock on wood. Not sick once all year. I did make sure I got my flu shot but it is amazing the difference because of the environment I was and am now working.

        BTW, sometimes elderly people can not move fast enough to cover their mouths and yes, you do get sprayed accidentally once in awhile. Also, I do make sure I use the wipes provided when I walk into the store to clean off the handle of the grocery cart. I am not a germaphobic, although I know a few and they seem to always be getting colds or the latest thing going around.

        Wishing our lives away for '08

        by BarnBabe on Sun Feb 25, 2007 at 10:55:02 AM PST

        [ Parent ]

  •  There you go again! (7+ / 0-)

     I am so sick and tired of all these doom and gloom scenarios. What is wrong with you people? We live in the greatest country on earth and our free enterprise system can handle anything, just like we won World War II.

     You people have been telling us for years that things are going downhill. You warned that Population Growth was going to overwhelm the planet. People would starve, fisheries would collapse. Well, I can go into any grocery store and find tons of food.

     And hey, what about that global warming crap? I've got over a foot of snow outside my window right now. Sure I live in the northeast and it's late February - but where are those palm trees Al Gore promised me?

     Oh sure you said for years a hurricane would wipe out New Orleans - turns out Katrina wasn't the monster everyone said it would be, and anyway it turns out the stupid government didn't build the levees right, so what did you expect.

      Why you people would have me believe the only super power left standing in the world can't handle a piddling little sand box like Iraq. Heck, if you idiots didn't force the military to keep one hand tied behind its back and say 'pretty please' we would have all them Ay-rabs straightened out by now. It's not our fault if Democracy is too good for 'em.

        Don't you get it? This is AMERICA. If you Godless types don't piss off the Big Guy with your gay marriages,  we'll be just fine like always.

       You "Nattering Nabobs of Negativism!" You make me sick.  

    Or is that the flu.....Cough, cough, wheeze..gasp...THUD!

    "No special skill, no standard attitude, no technology, and no organization - no matter how valuable - can safely replace thought itself."

    by xaxnar on Sun Feb 25, 2007 at 08:42:32 AM PST

  •  1918 influenza may have been unique (3+ / 0-)
    Recommended by:
    Pandora, ekwhite, Winnie

    I think the uncertainty is a big thing here.  It is clear that there will eventually be another flu pandemic affecting millions, but that is about all that is clear.  I think you are right to add that "whatever the number," we are not prepared.

    It is really difficult to estimate the number that will be killed by the next pandemic. One recent study suggested that the 1918 virus may have had a unique combination of genes that attacked in two different ways at once.  If we're lucky, that could mean that future pandemics might not be quite so devastating.  I don't think it is possible to compare it to the current H5N1 mortality rate either.  The recent Asian victims have usually been in continued contact with infected birds and living in areas with poor medical care, and the sample size is too low to know if they represent the resistance of the general population.  If it moves through industrial populations of healthy adults with good medical care (although many won't have access in a pandemic), who knows what mortality rates would end result?  On the other hand, the number sickened and needing health care might be more predictable, as I would think that transmission rates are probably more consistent among different viruses than are mortality rates.

    •  1918 may have been unique compared to 1957 (8+ / 0-)

      and 1968, but H5N1 may be another kind of unique. it's the worst virus any of the flu researchers have ever seen, even compared to 1918.

      Think on it.. in humans, the H5N1 has a case fatality rate of >50% whereas 1918 was 2.5% (much greater in certain spots... it devastated remote villages). and, like 1918, it looks like H5N1 can jump from birds to humans without reassorting and mixing with another virus. It has already done so 274 times 9confirmed cases by WHO), and in indonesia, only half the cases were from poultry... the rest were unknown source (cats and other mammals are also affected). Respect this virus.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 25, 2007 at 08:57:07 AM PST

      [ Parent ]

    •  I agree - uncertainty is a big thing here (4+ / 0-)
      Recommended by:
      cookiebear, splashy, Winnie, willers

      However, more and more people are thinking that the H5N1 virus is looking similar to the 1918 virus:

      The 1918 virus jumped right from birds to people. There was no combining with other viruses. One of the problems we've had is, if you look at the 1918 virus and this one, they're in essence kissing cousins. Genetically, these things look very similar. Frank Obenauer and colleagues just published a paper the last week of January in Science, and they actually have gone back and looked at the full genetic codes for 169 avian virus genomes, dating way back. They looked at 2,169 distinct avian genes. There were two viruses that showed a protein tag at the end of one of the nonstructural genes that actually looks to help caue the cytokine storm that makes this a unique illness.   And guess which two viruses they were: 1918 H1N1 and the current H5N1.

      Including WHO

      Avian Influenza Patterns Resemble 1918 Pandemic

      "War doesn't determine who is right, war determines who is left." ~ Bertrand Russell

      by Pandora on Sun Feb 25, 2007 at 09:35:42 AM PST

      [ Parent ]

    •  you mean like Sweden? (2+ / 0-)
      Recommended by:
      DaleA, willers

      "If it moves through industrial populations of healthy adults with good medical care"

      1/3 adults here are overweight or obese, many have high bp, or diabeties. A huge number don't have a regular doctor, or health insurance.

      What makes you think the average American will be much better off during a pandemic?

      fact does not require fiction for balance

      by mollyd on Sun Feb 25, 2007 at 11:08:01 AM PST

      [ Parent ]

    •  the joke to this (1+ / 0-)
      Recommended by:
      DaleA

      is that more and more populations have less and less access to healthcare.  The goal of many executives now is to build an empire, not to build a healthy community.

      •  You can't make money off of healthy people (0+ / 0-)

        That's why there is a lack of emphasis on preventative care in this country.

        Healthcare is big business.

        •  you can make money off dead people (0+ / 0-)

          so from a financial point of view, it is preferable to have the chronically ill indigent go ahead and die from their diseases while you preserve your resources for those who can pay.  The paying customers you keep alive.
          Kind of economic genocide now I think about it, and subtle too.  

  •  one reason why hospitals (4+ / 0-)
    Recommended by:
    RunawayRose, DaleA, Winnie, willers

    are trying to cut costs, are closing etc. is because there isn't as much of a need for hospital beds (under normal circumstances--perhaps not in the middle of a winter flu season...) as there used to be. This is because so much of medical care has moved to outpatient treatment. People are given medication to treat their heart disease or whatever instead of being kept in the hospital. Hospitals have a hard time making money anymore.

    This is what a relative who is a finance guy for a major health chain told me, anyhow.

    At any rate, I think that if a flu pandemic arrives, we're going to need more beds than what hospitals have anyhow. Schools, community centers etc. are going to have to be used.  So yes, we're talking about planning ahead---which rarely happens for anything in this country.  

  •  Only in America (4+ / 0-)
    Recommended by:
    LIsoundview, m00nchild, DaleA, tzt

    Jeez. I run down the thread looking for points concerning disaster prevention and mitigation, and find discussions of ammunition. Can't you people ever let go of your "Farnham's Freehold" fantasies? I can't think of any other society on earth not actively involved in a civil war so obsessed with lethal hardware.

    I'm beginning to suspect that a plausible scenario for a worldwide flu epidemic will involve societies across the world pulling together and working through the disaster, everywhere but in the United States, where you will be too busy re-enacting the Wild West and shooting each other.

    The rustling noise you hear on the wind will be the world's laughter.

    Through tattered clothes great vices do appear / Robes and furr'd gowns hide all. (King Lear)

    by sagesource on Sun Feb 25, 2007 at 09:00:54 AM PST

  •  Tamiflu (5+ / 0-)
    Recommended by:
    Athena, DaleA, splashy, Winnie, willers

    Took me an extraordinary effort to even get a tamiflu script and when I finally did my med. Ins. refused to fill it! But, I hear the rich and powerful all have it as do the leaderships of the States and Big companies. The truth nobody gives a shit what happens to the rest of us if this thing hits. It will be like New Orleans when Katrina hit YOYO !!

    "It's better to die on your feet then live on your knees" E. Zapata

    by Blutodog on Sun Feb 25, 2007 at 09:04:42 AM PST

    •  Help (1+ / 0-)
      Recommended by:
      Winnie

      How did you obtain Tamiflu.  I.e., what were the specific actions you took?  I'm interested in stockpiling the medication, just in case.

      Question authoritarianism

      by m00nchild on Sun Feb 25, 2007 at 09:55:04 AM PST

      [ Parent ]

      •  Asked my Dr. (0+ / 0-)

        I asked my kids Dr. and had to write her a long letter essentially telling her nicely, if she denied me the script and either of them died behind this denial, I'd sue the crap out of her. She very grudgingly gave it too me.

        "It's better to die on your feet then live on your knees" E. Zapata

        by Blutodog on Sun Feb 25, 2007 at 02:16:55 PM PST

        [ Parent ]

        •  Oh good. (1+ / 0-)
          Recommended by:
          DaleA
          Well done, then - getting a prescription that you don't need by bullying your doctor.

          I have to point out that while Tamiflu is thought to potentially be helpful, it has some fairly bad side effects and so far has shown only limited effectiveness. If you respect your doctor's opinion so little, I suggest you find another.

          Will you sue her if one of your children dies because of a bad reaction to Tamiflu when there's no medical help available?

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Sun Feb 25, 2007 at 04:23:17 PM PST

          [ Parent ]

          •  Easy 4 u to say. (0+ / 0-)

            Look it's my kids I don't need u or anyone else including my so called Dr. telling me how to protect them. Call it bullying if u want I could care less.

            "It's better to die on your feet then live on your knees" E. Zapata

            by Blutodog on Sun Feb 25, 2007 at 06:03:59 PM PST

            [ Parent ]

    •  tamiflu (0+ / 0-)

      Are you also taken steps to not be bitten by a shark?

      What about protection against lightning strikes?

      Why?

      Right now, it is extremely difficult to die of Avainflu.

      You have a >>>far better chance<<< of being bitten and killed by a shark (bless their hearts) as well as being struck by lightning.</p>

    •  anti-viral medication such as Tamiflu (0+ / 0-)

      is most effective when used within 48 hours of onset of illness, but it's effectiveness against a future pandemic strain is unknown.

  •  Well, it's up to our citizens (2+ / 0-)
    Recommended by:
    Winnie, willers

    To stock up on food, water and guns so that they can hole up in their basements for extended periods, since no one will tolerate the cost of maintaining adequate resources for sufficient response to disasters . . . at least that seems to be the current attitude of the present Administration.  

    We can spend a billion dollars a day occupying foreign countries to respond to a non-existent threat, but can't spend money on the real threats to average people.

  •  Surplus Hospital Beds (2+ / 0-)
    Recommended by:
    Athena, Winnie

    New York State is currently in the process of dumping several hospitals specifically so we aren't paying for roughly 20,000 empty hospital beds that are routinely there in "normal" days.

    An empty hospital bed today is crucial emergency capacity during a pandemic, natural disaster, industrial mishap or a terrorist attack.

    Perhaps a hospital bed is not the best way of ensuring that we have such emergency capacity.  I can certainly see that, given expensive staffing, cleaning, administration, utilities and maintenance costs, it's not a cheap means of disaster preparedness (though many of those empty beds are in closed wards, which are cheaper).  Perhaps mobile emergency units that can rapidly deploy hundreds of beds in stadiums, hotels, emergency tents, whatever, might be a better way to go,

    But, if an empty hospital bed isn't the way to go, I'd really prefer to see that we have whatever alternative we choose in place before we close more hospitals.  I'd hate to see another disaster happen during a period when the state is even less prepared than we were for 9/11.

  •  I'm HIV+ (3+ / 0-)
    Recommended by:
    DaleA, Winnie, willers

    I'm single.  I live alone in an urban area (SF).  Although I have some good friends here, my family lives in Houston and my closest friends live all over the world.

    I've been reading your postings here and lurking on the Fluewiki forums and it certainly has me thinking and and I'm starting to prepare now.  I have and am continuing to stockpile 90 days of food, OTC medical supplies, and other emergency necessities.

    Like you and others have emphasized:  that I prepare this way specifically for a flu pandemic in way way compromises my efforts to be prepared for all sorts of other disaster that can affect me in this area -- including earthquakes and the mess that follows.

    But I am trying to gauge the effectiveness of some choices vs. other choices.

    For instance, should I hear that we've moved into level 5 on the pandemic scale, should I, instead of battening down the hatches on my own here in SF, board a plane to Houston, or elsewhere and be with loved ones?

    Or, if I am completely on my own during a wave, should I just lock the door and stay home for 6-12 weeks and hope that civil services don't break down to the point that my neighborhood's safety becomes an issue?

    Furthermore, with my HIV+ status I wonder if completely isolating actually is the best policy so I come into contact with no one or no thing that could potentially pass on the flu to me?

    And in that regard I wonder about how to stockpile meds.  I'm currently not on ARV medication for HIV as I'm early stage and showing signs that I might be  a long term non-progressor, but if that changes and a pandemic breaks out, how can i secure/stockpile 3 months of medication in advance -- because if my treatment for HIV is interrupted I could seriously compromise my health.  Can I have my doctor write me a three month's supply and just pay for it with cash (eek, that's $3-4 THOUSAND!) and immediately follow that up with a regular monthly prescription that gets processed by insurance so I always have an extra 90 day supply?

    Question authoritarianism

    by m00nchild on Sun Feb 25, 2007 at 09:52:25 AM PST

  •  I think the stomach virus that went around (2+ / 0-)
    Recommended by:
    splashy, Winnie

    shows how out of control a true pandemic would get. This stomach bug started on cruise ships, and has spread all over the country this year. Everyone has had it or knows someone who has had it.

    We will be in deep trouble if a serious pandemic occurs. The medical profession is totally unprepared to  deal with it.

  •  Prepare yourselves now. (5+ / 0-)
    Recommended by:
    Athena, Winnie, willers, Tigana, Miss Mannered

    The grim reality is that in an emergency, you cannot count on the government to restore services and other essential needs.  And we all know that this particular, Bush-misled government can be counted on to only make matters worse.

    Everyone MUST have at least three days supplies of everything they need, including water, in their homes.

    However, anything from bird flu to a sudden oil crisis (e.g., a war in the Persian Gulf which disrupts tanker transportation) can severely disrupt the supply chain.  If possible, try to store up several weeks worth of stuff.  Think about stuff that will disappear from stores' shelves quickly, like soap and toilet paper and detergent and all the boring stuff you rely on.  Don't forget about your pets' needs.

    Have bleach to decontaminate water.  Have cooking oil to consume one tablespoon/day for your endocrine system.  Stock up on cheap, crappy soda, since it's a long-term supply of both liquids and sugar.  Buy lots of vitamins.  Buy lots of meals-ready-to-eat, since they last forever.  Oy, the list is endless, and you can google recommended supplies.

    The good news is that it's not a waste of money if nothing happens.  Every year you can check the expiration dates on your stuff.  If it's going bad in a few months, donate it to a food bank, animal shelter, etc.  You can write off the donation.  Then, replenish.

    It all sounds crazy, and it is, but think about how much better off many people in the Gulf Coast would have been if they'd had supplies on hand.

    "No doubt Jack the Ripper excused himself on the grounds that it was human nature." A.A. Milne

    by DurianJoe on Sun Feb 25, 2007 at 10:39:03 AM PST

    •  Good nutrition can protect you (0+ / 0-)

      Thank you for the valuable information in this post, DurianJoe.

      See my art at http://cafepress.com/peaceangel/ and http://cafepress.com/algore08

      by Tigana on Sun Feb 25, 2007 at 11:02:20 AM PST

      [ Parent ]

    •  could you please say more about these two (0+ / 0-)

      statements?

      Have bleach to decontaminate water.  Have cooking oil to consume one tablespoon/day for your endocrine system.

      How much bleach to decontaminate?
      How does cooking oil help endocrine system?
      For that matter, what is an endocrine system?

      sorry to sound so ignorant.

      thanks

      •  decontaminating water (0+ / 0-)

        Make sure you use plain, unscented bleach. The scented kind might have nasty chemicals you don't want to drink.

        EPA page here

        Put 8 drops of bleach for a gallon of water. Let sit for 30 minutes or so covered. Then you can air it out to reduce the bleach smell. You can also put in a few drops of hydrogen peroxide, which neutralizes the bleach smell.

        Fresh bleach is better than old bleach. If you have had a bottle of bleach sitting around for 3 years, you might have to put in more, but I don't know the calculation.

        You can also boil water to purify it. Boiling is better. Bleach will kill most nasties, but it won't kill giardia or cryptosporidium (which is found in streams). If you're collecting water from streams to drink, you should boil it.

        humani nil a me alienum puto (I consider nothing human foreign to me) --Terence

        by astraea on Sun Feb 25, 2007 at 12:22:37 PM PST

        [ Parent ]

      •  The endocrine system and you. (2+ / 0-)
        Recommended by:
        DaleA, Winnie

        The endocrine system and the hormones they release influence almost every cell, organ, and function of our bodies. The endocrine system is instrumental in regulating mood, growth and development, tissue function, and metabolism, as well as sexual function and reproductive processes.

        Prisoners in the Soviet gulag in Siberia ingested vegetable oil for sterols, which are substances that keep your endocrine system healthy.

        In my house, we have a huge container of generic canola oil with our emergency supplies.  In a worst case scenario, we'd use it at one tablespoon/day per person to help keep healthy.  The oil is relatively inexpensive and, again, can be donated and replaced when it nears its expiration date.

        "No doubt Jack the Ripper excused himself on the grounds that it was human nature." A.A. Milne

        by DurianJoe on Sun Feb 25, 2007 at 02:54:46 PM PST

        [ Parent ]

    •  Don't Forget Weapons (0+ / 0-)

      While you're at it, you might as well buy guns too.  Several 12-gauge, pump shotguns should do the trick.  You can use the shot to hunt game and slugs for people.  One should always be fully prepared for times like these.

      "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

      by PrahaPartizan on Sun Feb 25, 2007 at 11:58:06 AM PST

      [ Parent ]

      •  Shotguns for home defense, not for hunting. (0+ / 0-)

        I agree completely about having a shotgun for home defense.  If it all hits the fan, then it's possible you'll need to defend your home from roving thugs.  (Or zombies, depending on how mutated that flu gets).

        As for hunting:  the human race has done enough damage to other animals, and bird flu is arguably the result of people raising certain birds as food.  Like I've said, bird flu would be karmic payback.  Instead of killing more animals, people can stock up now on dried lentils and other legumes, and dried grains like rice and quinoa.  You'll get all the nutrients you need without spilling blood.

        "No doubt Jack the Ripper excused himself on the grounds that it was human nature." A.A. Milne

        by DurianJoe on Sun Feb 25, 2007 at 02:34:07 PM PST

        [ Parent ]

        •  then the roving bands of thugs (0+ / 0-)

          who thought to pick up highpowered deer rifles will sit back and pick you off at their liesure from 100 yds out with their .30-06 or even .223.

          •  They'll get you too, then. (0+ / 0-)

            If that's the case, you can be armed with a 50 mm sniper rifle, and you'll still be vulnerable to a halfwitted thug with a hunting rifle.

            Best to stay under cover when the fit hits the shan.

            "No doubt Jack the Ripper excused himself on the grounds that it was human nature." A.A. Milne

            by DurianJoe on Tue Feb 27, 2007 at 07:11:41 PM PST

            [ Parent ]

  •  Not only that, it's "you Gotta Play Hurt" (6+ / 0-)
    Recommended by:
    Athena, elfling, DaleA, splashy, Winnie, willers

    Whether it's sending your kids to school sick 'cause you gotta work, or going to work yourself when you're sick, people just have to start playing smart.
    Our workaholic American Society must stop seeing people felled by a cold or flu as "weak" and begin understanding that when you first feel ill is the time to stay home. With almost everything, once you're sick, you're almost past contagious. So if you have a scratchy throat and sniffles on a Sunday night, You'd be far better off staying home Monday than going in and infecting everyone else.
    I'm tired of the "wimp" factor, telling folks, you gotta suck it up and go to work no matter how bad you feel, or practically needing an note from the doctor stating you need chemo before someone lets you take a day.
    For cryin' out loud people, what if something like bird flu gets here? All those, "you gotta play hurt" assholes are the ones who will endanger us all.

    "Keep raisin' hell!" - Molly Ivins

    by MA Liberal on Sun Feb 25, 2007 at 10:58:48 AM PST

  •  Factory Farming - incubator for illness (2+ / 0-)
    Recommended by:
    Winnie, willers

    Interesting dKos diary posted here:
    http://www.dailykos.com/...

    See my art at http://cafepress.com/peaceangel/ and http://cafepress.com/algore08

    by Tigana on Sun Feb 25, 2007 at 11:03:22 AM PST

  •  Possible Flu Pandemic (0+ / 0-)

    Why don't we put in place a system (socialized medicine)that would significantly decrease phyisician's income.  There by making the medical profession less attractive to America's best and brightest students.  Then we can have, at best, fewer doctors or worse fewer and less intelligent doctors to treat the sick.  However there will be plenty of ambulance chasers (sorry, trial lawyers, eg. former Sen. Edwards).

    Or better yet, let's start punishing the pharmaceutical companies.  We should tax them so there is hardly a hint of profit for the biggest and newer and smaller ones will close.  That way we can be sure no new vaccines will be made available to treat the next flu or anyother sickness such as cancer or AIDS.  

    But do not worry. Maybe we can find some shaman who has some magical berry.  But I am afraid the best of them were killed off by the evil whiteman and their damn smallpox.

    •  A little off topic for this post (2+ / 0-)
      Recommended by:
      DaleA, splashy

      since none of this troll rant has anything to do with what I wrote about. But to make it relevant:

      Investing billions in the pharmaceutical industry to increase vaccine production capacity is part of the panflu preparedness plan (google BARDA). But the market should be the guide... old-style egg based manufacturers should lose out to newer innovative companies, assuming the playing field is equal. Making sure it is, is the job of oversight and congress.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 25, 2007 at 12:13:17 PM PST

      [ Parent ]

    •  I realize you are snarking (1+ / 0-)
      Recommended by:
      DaleA

      but there is already a shortage of primary care doctors that is largely filled by H-1B FMGs.  The income, compared with the average healthcare executive is substantially less, the hours are appreciably longer, and the work much harder, physically and mentally.
      Add to that fewer primary care physicians choosing private practice and the cost of an independent practice's bringing on a new doctor and you can look to the 1980s and the acquisition of physician practices by hospitals as the beginning of medicine as we had previously known it.
      Physicians have taken the same road as farmers, as farmers moved to employee status and farming became corporate so most primary care physicians are now employees and most clinics are part of a larger corporation.  Even more daunting is present law and regulations encourage this state of affairs so that hospitals have incentives to ensure they hold a monopoly on healthcare in their service area.    

  •  call it what it is (0+ / 0-)

    Hospitals are not seeking to cut costs; they are seeking to maximize profits.  Too many hospitals use their tax exempt status to bludgeon competitors while failing to provide the charity care they are supposedly constrained to provide by the IRS.
    Instead, they are allowed clever paper tricks where bad debts are double counted as charity care and triple counted as they are sent for collections and contractually agreed write-offs for third party carriers are written off as charity care.

    Check the income for the top echelon healthcare executives and the average income for the community. The community hospital got tagged by the OIG for overpaying several physicians by several magnitudes of the FMV of their services.  The result?
    One resignation but everyone else moved up a slot and no one paid any money back from their own paychecks. It is a charge-off against future profits.  

  •  THANK YOU (2+ / 0-)
    Recommended by:
    DaleA, splashy

    I want to thank you for keeping at it, for continuing to warn and hammer this point home that THIS IS FREAKIN REAL, AND PEOPLE WILL DIE.

    I am SO tired of people who whine that you and I are "fearmongers" because we dare to speak uncomfortable truths that, if they actually decided to act, would make them have to (GASP!) DO SOMETHING other than sit on their butts and eat corn chips while viewing Britney's baldness.

    PEOPLE. WHAT CAN IT HURT TO BE PREPARED? Why is there this severe allergic reaction to putting a few gallons of water in your garage and having a working camp stove and some canned food? Why does it give you the hives to put some flashlights and batteries in an easiy-accessible place or to have a "bug out bag" ready in case you have to evacuate for whatever reason?

    So again, DemfromCT, THANK YOU for at least trying to get this point across, with multiple links and facts. It's easy to say to yourself "screw the world, I have mine, to hell with the fools who won't listen" but that's the easy way out -- the more people who are prepared, the fewer there will be that will come to you later and demand help, as if they are entitled to what you have. How childish, like the boy who eats up his ice cream faster and then demands some from his friend because she has some left on the stick.

    This nation has been lulled into complaicency, has been taught that "the bad old times are over" and that we will never be without anything we want ever again. Too many people shop the same day for that evening's dinner ingredients... too many people don't even know how to cook at all. I am scared and sad for them, I really am. Those who cannot even cook their own food will be among the first to die.

    Spring is coming, America... and with it, hope once again.

    by willers on Sun Feb 25, 2007 at 01:05:21 PM PST

  •  Rather than emphasizing anti-viral medication (3+ / 0-)
    Recommended by:
    DemFromCT, DaleA, splashy

    or the flu vaccine (which will take 4-6 months to prepare) to save the day, there's a lot that people can be doing right now to prepare for the pandemic flu should it occur, and increases their chances of surviving.

    There's no way to know how bad the flu epidemic will be, so I am preparing for the worst case scenario. I'm also trying to get my neighbors and the surrounding homeless shelters prepared by distributing literature from the public health department, organizing meetings, and talking one-on-one with individuals.

    In the worst case scenario, our local public health department says that 40% of working Americans will be out sick. They predict that there will be significant disruptions in shipping and transportation, and are telling people that they may need to rely on themselves and cannot expect any outside help because all areas will be equally affected. They are advising people to set aside enough food, water, medication, etc. to hold them over until conditions return to normal (several weeks?). People also cannot assume that if they get sick they will be able to go to the hospital. They predict that there will not be enough hospital beds to care for everyone who is sick and most of the care for flu patients will have to take place in the community: friends, families and neighbors taking care of each other. So it is a good idea to get a plan into place, and prepare for something that the CDC is certain will happen. They just don't know how bad and when.

    •  very sensible (1+ / 0-)
      Recommended by:
      DaleA

      and note that it is the health department and the CDC as well as experts in virology, infectious disease, epidemiology, disaster relief, etc who are on the cutting edge of giving this advice.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 25, 2007 at 01:32:24 PM PST

      [ Parent ]

  •  Flu prep Homeland Security job = Bush Jr failure (1+ / 0-)
    Recommended by:
    DaleA

    Flu pandemic has to be part of Homeland Security and one of its priorities.

    As always, another job the Bush Jr admin. has failed  to do.

    This is particularly true since it also dovetails with any biological terrorist attack.

    A huge problem with a flu pandemic is the disruption of vital services due to people being sick and off the job.

    The entire infrastructure becomes dysfunctional at a time when there is increased need for it, deliveries for food, fuel, water.

    In the medical area, the single biggest factor is providing artificial breathing assistance as the flu kills by fluid in lungs.  There need to be stockpiles of breathing apparatus. People can be treated in the home if the apparatus is available. If they can be kept breathing, good chance of survival.  Home treatment keeps the disease from spreading and keeps hospitals from being overwhelmed.

    •  Ventilators (0+ / 0-)

      These cannot be operated by lay people.  It takes a lot of training to use one of these properly.

      •  Home ventilators a part of std. home health care (0+ / 0-)

        Hundreds of thousands of families operate ventilators at home now. It's part of home health care.

        •  There are 100,000 (0+ / 0-)

          ventilators in the US and and 80% are in use on any given day.  Most of them are in hospitals.  Lay people can be trained to use them, but it takes time and training to learn to do it without harming the patient.

          •  Learn a Little (0+ / 0-)

            Here's what is required to entubate a patient and operate a ventilator:

            The nurse must be able to do the following:

               1. Identify the indications for mechanical ventilation.

               2. List the steps in preparing a patient for intubation.

               3. Determine the FIO2, tidal volume, rate and mode of ventilation on a given

               ventilator.

               4. Describe the various modes of ventilation and their implications.

               5. Describe at least two complications associated with patient’s response to mechanical ventilation and their signs and symptoms.

               6. Describe the causes and nursing measures taken when trouble-shooting ventilator alarms.

               7. Describe preventative measures aimed at preventing selected other complications related to endotracheal intubation.

               8. Give rationale for selected nursing interventions in the plan of care for the ventilated patient.

               9. Complete the care of the ventilated patient checklist.

               10. Complete the suctioning checklist.

                  1. To review indications for and basic modes of mechanical ventilation, possible complications that can occur, and nursing observations and procedures to detect and/or prevent such complications.
                  2. To provide a systematic nursing assessment procedure to ensure early detection of complications associated with mechanical ventilation.

            Indication for Intubation

               1. Acute respiratory failure evidenced by the lungs inability to maintain arterial oxygenation or eliminate carbon dioxide leading to tissue hypoxia in spite of low-flow or high-flow oxygen delivery devices. (Impaired gas exchange, airway obstruction or ventilation-perfusion abnormalities).

               2. In a patient with previously normal ABGs, the ABG results will be as follows:

                   PaO2 > 50 mm Hg with pH < 7.25

                   PaO2 <50 mm Hg on 60% FIO2 : restlessness, dyspnea, confusion, anxiety, tachypnea, tachycardia, and diaphoresis</p>

                   PaCO2 > 50 mm Hg : hypertension, irritability, somnolence (late), cyanosis (late), and LOC (late)

               3. Neuromuscular or neurogenic loss of respiratory regulation. (Impaired ventilation)

               4. Usual reasons for intubation: Airway maintenance, Secretion control, Oxygenation and Ventilation.

            Types of intubation: Orotracheal, Nasotracheal, Tracheostomy

            Preparing for Intubation

               1. Recognize the need for intubation.

               2. Notify physician and respiratory therapist. Ensure consent obtained if not emergency.

               3. Gather all necessary equipment:

                       a. Suction canister with regulator and connecting tubing

                       b. Sterile 14 Fr. suction catheter or closed in-line suction catheter

                       c. Sterile gloves

                       d. Normal saline

                       e. Yankuer suction-tip catheter and nasogastric tube

                       f. Intubation equipment: Manual resuscitator bag (MRB), Laryngoscope and blade, Wire guide, Water soluble lubricant, Cetacaine spray

                       g. Endotracheal attachment device (E-tad) or tape

                       h. Get order for initial ventilator settings

                       i. Sedation prn

                       j. Soft wrist restraints prn

                       k. Call for chest x-ray to confirm position of endotracheal tube

                       l. Provide emotional support as needed/ ensure family notified of change in condition.

            •  And we need to keep in mind... (0+ / 0-)

              There is a huge shortage of Registered Nurses who can care for seriously ill patients and in the event of a flu epidemic a huge number of them are going to be sick and unable to work.  

  •  Avianflu: Yawn!! B-O-R-I-N-G!!! (0+ / 1-)
    Recommended by:
    Hidden by:
    entlord1

    Please, I would like to know what the exact (or rough) odds are that Avian flu will mutate into a form that will be devastating to humans.

    Of all the viruses out there in recent times, how many have actually turned into forms that have decimated humans?

    Obviously, the Avian Flu scare is classic split-brained thinking which is cut from the exact same intellectual cloth of the Killer Bees, Y2K, The Rapture, Iraq's WMD, etc.

    People have been predicting such disasters forever.

    (Yawn!!!)

    The biggest difference, though, is that the M$ media, Pharm industry, and  the Bush admin are now **deeply** involved.

    •  interesting comment (1+ / 0-)
      Recommended by:
      splashy
      Okay, let's see... how many devastating viruses that might decimate humans ( and an 82% case fatality rate for H5N1 in 2007 certainly qualifies)  does it take to make abhinavagupta un-bored?

      If the answer's more than one, you got a problem, kid.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 25, 2007 at 05:24:38 PM PST

      [ Parent ]

    •  Your Ignorance is Showing (1+ / 0-)
      Recommended by:
      splashy

      When Michael Osterholm says We're screwed I'm going to pay a whole more attention to him than I am to you.

    •  We would all like to know... (0+ / 0-)

      what are the exact odds of the avian flu turning into a worldwide pandemic.  But 1918 was not the only pandemic of the flu.  The Asian Flu of 1957 killed 1.5 million people and the Hong Kong Flu of 1968 killed 1 million.    There is also the possibility of the H1N1 virus from the 1918 pandemic mutating into a deadly form again.

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