Pandemic Planning

The call comes from a private home, and the symptoms describe respiratory distress. The pandemic is underway, the vaccine has yet to arrive, and you're called to respond. What actions and precautions do you take?

     Consider a municipality of, say, 216,000 people. The CDC flu surge model projects that a pandemic influenza will affect 15%-35% of a given population, with a likely scenario of 25%. This translates to an estimated 54,000 who will contract pandemic influenza in this particular jurisdiction. Of those, around 800 will require hospitalization, and about 161 will die. Is your agency prepared to manage the number of patients this scenario projects?

     If EMS responds to each of these calls, your department's transport capabilities will quickly be exhausted, and local hospitals will soon be overwhelmed. Therefore, you must have an emergency response plan in place that can triage pandemic influenza patients from those with seasonal influenza or who simply believe they have pandemic influenza (the worried well).

     Preparing a pandemic influenza response plan should raise several critical questions among EMS leaders and field personnel. The process will not only prompt a review of existing emergency plans, but challenge your department's standard operating procedures as well.

1. Has your 9-1-1 call center set up a triage process to distinguish callers with pandemic influenza from those with seasonal influenza?
2. When EMS arrives on a call scene, can responders differentiate symptoms to confirm pandemic influenza vs. seasonal influenza or even the worried well?
3. Do your responders know proper infection control and PPE for both the patient and themselves?
4. Due to the projected volume of patients, has your service considered multiple patients per ambulance run?
5. What about alternative transport vehicles (vans, buses)?
6. Has your service established a liberal sick-leave policy and encouraged use of that sick leave for EMS responders exhibiting symptoms of, or documented illness with, pandemic influenza?
7. Finally, have you written your pandemic influenza response plan?

     This article will take you through each of these steps and offer insights into the thinking of pandemic influenza planners on these topics.

Telephone Triage
     Hospitals have limited bed capacities today, and while systems are attempting to increase their capacities, there may never be enough beds to handle the volume of patients a pandemic influenza could generate.

     But if your community is like most, bed capacity will not be the only limited resource. Ambulances and personnel will also be in short supply, and this will compound the challenge to a community's medical system. This is all the more reason for call center personnel to gear up for the role of triage. Call centers can support the medical system by triaging callers reporting symptoms and distinguishing the most critical from those with seasonal influenza or the worried well. That plan should also include training nonessential personnel to take on the duties of call center triage should 9-1-1 personnel become unavailable.

     Public-health officials throughout the country are working to prepare first responders to respond to pandemic influenza. Tap their expertise and take the time to train and exercise with your local department of health. They have the resources to bring your people up to speed, along with the expertise to help develop scripts needed for telephone triage.