Swine Flu: How a Hospital Prepares for Patients

From Our Doctor's Views Archive

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Practice makes perfect in most walks of life. From sports to music, from school to trades, the opportunity to practice an activity develops skills that get better and better with each repetition. So it goes for hospitals and disaster drills, practicing to care for large numbers of potential victims. Whether it is a natural disaster with numerous injured patients or a medical crisis such as the swine flu (now being referred to as the H1N1 influenza) in the spring of 2009, the people that staff a hospital need to be able to react when a surge of patients arrives at the door.

The swine flu outbreak showcased the planning and preparation that occurs at every hospital. When a patient with symptoms of swine flu shows up at the hospital door, not only does that person need to be treated, but a system needs to be in place to prevent the rest of the patients and staff in the hospital from becoming infected by that patient. What can be done?

Even before a patient enters the building, hopefully public education efforts have told them to call ahead and let the ER, the clinic, or the doctor's office know they are coming so that they can be met prior to entering the building and be given a mask. It doesn't do much good to walk up to a desk unannounced and potentially infect the receptionist.

A triage, or screening, exam might be done to assess whether the symptoms may be potentially due to swine flu. The exam might be brief, involving a few questions and perhaps recording a temperature, accessing for fever. Again, little benefit occurs if the nurse doing the initial exam is exposed to the virus. Don't be surprised if the medical staff are wearing masks in addition to the patient.

If swine flu is a concern, the patient might be taken directly to an isolation room so that he or she is removed from other people in a waiting room or main treatment area. The isolation room may have special air flow and filters to prevent virus spread by coughing or sneezing.

Once the patient leaves, the room needs to be cleaned thoroughly, since the swine flu virus can live on countertops or other surfaces for up to two hours.

These steps seem reasonable and seemingly easy to implement for one patient. But if medical facilities become inundated with scores of patients, there needs to be a systematic approach to prevent becoming overwhelmed by sheer numbers.

Some hospitals may set up triage tents in parking lots, examining patients before they enter the building. Those who aren't significantly ill may be sent home, allowing only those with more critical symptoms to enter the hospital. Since the virus spreads among people in close quarters, using large outdoor spaces that provide good ventilation goes a long way toward prevention of infection.

Health care staff training will stress the compulsive use of face masks and hand washing to avoid getting ill or passing the infection along to others. The housekeeping and laundry crew will work overtime to keep the hospital clean and as sterile as possible. But if enough people require hospitalization, there may not be enough isolation rooms to deal with the potential number of sick people, and the hospital itself may need to come under quarantine, not letting people come or go until the threat of contamination lessens. Imagine the commitment required by health care workers to come to work, knowing that they may not be able to leave for home for days. Imagine the dedication of those who willfully risk infection to care for those who are ill.

So, a plan exists for those patients with swine flu. But what happens to the rest of the world, those who are going on with their lives and experiencing heart attacks, strokes, motor vehicle accidents, and a sundry of other accidents and illnesses? Life does not stop for them, and the medical system needs to be able to care for these people as well. Emergency planning attempts to minimize the effect that the surge of potential swine flu patients has on the ability of the hospital, the doctors, the nurses, and the support staff to care for other patients.

Public education will hopefully teach the non-critically ill patient what to do if they think they may have swine flu. Not every person with the symptoms of fever, chills, aches, and cough, even if it may be swine flu, needs to be seen emergently for care. Often a telephone call to the family physician, the health department, or hospital may be all that is needed to get information and perhaps medication if it is warranted.

However, swine flu can make people very ill. Dehydration and pneumonia may be life-threatening, and it is just as important to know when to seek medical care as it is to know when to stay home.

• Pneumonia presents with shortness of breath, pain with breathing, fever, and cough. If there is dizziness, lightheadedness, confusion, and decreased urination, dehydration may be occurring.
  
  
• In infants and children, warning signs that medical care should be sought include: trouble breathing (wheezing, rapid breathing, and increased cough), irritability, decreased muscle tone, decreased urination, uncontrolled fever, and rash.

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It seems that what's old is new again when it comes to swine flu and immunizations. When flu season arrives, it may be the elderly, who have been exposed to the flu bug many years ago, are at an advantage when it comes to making antibodies and being ready to fight a new infection. And it seems that the younger you are, the more at risk for developing complications of swine flu. This is especially true for those who are young and pregnant.

Hospitals and clinics have become used to the annual rise in patients presenting with flu-like illnesses. The unexpected outbreak of the swine flu (H1N1 influenza) in the spring of 2009 tested the systems and for the most part, the medical system was up to the task in caring for those in need. Little should change in those systems should they need to be ramped up to care for a potentially large number of ill patients during the flu season. Ideally, the goal will be prevention of swine flu and minimizing the spread, rather than trying to care for all those who are ill.

As the pharmaceutical companies are getting ready to role out their annual influenza immunization vaccines, who gets immunized and when will be an important public health decision. While a government agency can make recommendations, it will be up to the individual patient to get help from their care provider to decide if and when immunization should take place.

As a take home note, remember, during the 2007-0008 flu season, approximately 36,000 people in the U.S. died from the flu. Do we panic and raid stores of masks, hand sanitizers, and become overly stressed during the regular flu season? No. In fact, it's difficult to get a lot of people to comply and get a free flu vaccine to prevent the flu. Hopefully, during the flu season people will be more vigilant about getting the flu vaccination if it is recommended to them.