For the latest details on the Implementation Plan and the status of these and other action items, visit www.pandemicflu.gov.
Federal, State, and Local–A Crucial Mix
In addition to providing overall planning and support, says Dr. Pile, “the federal government will also be responsible for helping to supply assets to states and regions that may be overwhelmed” during a pandemic flu outbreak.
Specifically, the government oversees the Strategic National Stockpile (SNS) program, which manages large quantities of medicine and medical supplies. These materials are stockpiled, ready to use in the event of a public health emergency. When federal and local authorities agree that the SNS is needed, supplies will be delivered to any state within 12 hours. Each state has plans to distribute so-called push packs of medicine and medical supplies to affected communities as quickly as possible.
“I’m not sure the federal government will be able to reliably deliver these push packs in a timely manner in the event of a severe, multi-state pandemic,” says Dr. Pile. “During Hurricane Katrina, which certainly posed challenges different from a pandemic flu outbreak but also included a number of similarities, we saw the struggle of the national government to react quickly.” He believes that the stockpiles may not be adequate in a worst-case scenario, such as a pandemic flu on the scale of the 1918 flu epidemic.
“It’s clear there just aren’t enough mechanical ventilators in the country to provide adequate surge capacity in the event of a severe pandemic, with best estimates of 80,000 to 105,000 ventilators nationally, most of which are in use at any given time,” he says.
Another issue is how much help the federal government can actually provide in the event of a pandemic flu. “Some government agencies and individuals have stressed that if there is a really catastrophic national influenza pandemic, the cavalry is not necessarily going to be coming,” says Dr. Pile. “Individual hospitals and regions will very possibly need to rely on their intrinsic resources, at least initially.”
So when a pandemic flu outbreak begins, where can hospitals find support? “HHS will take the lead role at the federal level,” says Dr. Pile. “State departments of health will oversee the response for each state. And at the city and municipal level, it will vary.”
The Role of Hospitalists
At this point, while all levels of government are still shaping plans for handling pandemic flu, what should hospitalists do?
“Hopefully, they’re involved in planning within their own institutions and regionally,” says Dr. Pile. “If not, that’s a great role for them. However, a lot of the people involved in [pandemic flu response] planning are not familiar with hospitalists.”
Woodruff J. English II, MD, hospitalist and co-director of Hospitalist Program, Providence St. Vincent Medical Center, Portland, Ore., is in charge of emergency preparedness, including pandemic flu, for his institution. He worked with his state department of health and the CDC. After conducting a tabletop exercise, Providence St. Vincent Medical Center has a plan in place that includes a number of tents that can set up as triage space for admitting and screening patients, plans to secure the hospital against riots and looters, staffing issues, and much more. “We’re figuring out what questions to ask; I wouldn’t say we’re prepared,” says Dr. English. “We’re taking a careful look at how we do business.”
When a pandemic flu outbreak does occur, hospitalists throughout affected areas will definitely be involved.
“They’d play a front and center role,” speculates Dr. Pile. “Critical care would be rolled out of the critical care unit into other areas of the hospital. Clearly, there wouldn’t be enough critical care physicians, so hospitalists would have to step in.”