Jul 6, 2009 (CIDRAP News) The American College of Emergency Physicians (ACEP) recently released a plan to help emergency departments, first responders, and public health departments manage a surge in pandemic flu cases that many experts predict will happen this fall.
The 16-page plan was produced under a contract with the US Department of Health and Human Services (HHS) office of the Assistant Secretary for Preparedness and Response (ASPR) and its Emergency Care Coordination Center, ACEP said today in a press release. The document defines critical capabilities and suggests ways to achieve them, ACEP said.
"While H1N1's virulence is not predictable, it is expected to be highly contagious and will place added strains on the emergency care system," said Nicholas Jouriles, MD, president of the ACEP, in the statement.
He added that planning for a second wave will be successful only with cooperation between first responders and public health officials. The plan urges local ACEP chapters to enlist support from state and local health directors, local emergency managers, and political leaders for emergency planning efforts.
The main components of the plan, based on the federal template for managing biological threats, include situational awareness, protecting emergency department infrastructure and personnel, preventing service disruptions, organizing a timely surge response, and recovering to the previous status. Communications with local and state public health officials are crucial, and it's important to have agreements in place for the "triggers" authorities will use to "stand down" the pandemic plan, according to the document.
One of ACEP's key planning assumptions is that large volumes of vaccine against the novel H1N1 virus probably won't be available until mid October at the earliest and that the public won't be protected from infections until 2 weeks after a second injection.
As a result, if the second pandemic wave begins September, health officials may depend heavily on community mitigation strategies to slow the spread of the virus. Emergency departments will still face a surge of patients, but interventions such as school closures will likely strain the department workforces even further, the ACEP plan warns.
Social distancing measures will also affect critical infrastructure businesses and institutions, which may slow the flow of transportation and supplies. Emergency planners shouldn't assume that antiviral medications will be effective for a virus that may have undergone selection pressure between waves, the report notes.
"While the precise effects on emergency departments to function cannot be predicted with confidence, contingency plans should be made for a challenging scenario," the plan states.
The nation's economic problems and the importance of staying on the job may add to the pressures to keep schools open, the planners wrote. News reports of deaths in young people, an age-group currently bearing the brunt of illnesses, might fuel even more parents to seek medical care for their children.
The plan includes 27 capabilities for emergency department response to a severe novel H1N1 outbreak, each with suggested steps and an outline for what level of health or government group is responsible. For example, the plan covers personal protective equipment stockpiling, facility security, crowd management, alternate locations for triage and screening, and configuring waiting rooms for social distancing, if possible.
Stephen Cantrill, MD, an emergency department physician in Denver and a member of ACEP's clinical policy committee, told CIDRAP News that the novel influenza plan is also designed to raise awareness among emergency physicians. The potential burdens will be vast, he said, not only for keeping the workforce functioning during the surge, but also keeping departments adequately supplied.
"There are so many vulnerabilities in the supply chain, where do you start?" he asked, adding that even departments that are well prepared might not able to sustain their supplies.
The impact of the influenza pandemic on emergency departments will be affected greatly by how local public health officials craft their messages to the public, Cantrill said. He said the US Centers for Disease Control and Prevention (CDC) has done a good job communicating flu facts to the public, including details on when to seek medical care.
Jul 6 ACEP press release