# 2168
plan·a·ce·a n.
A mythical plan, guideline, or rule book for all emergencies, pandemics, or other crises; `A Plan for All Reasons'.
The following is part of a press release regarding an article in JAMA (Journal of the American Medical Association). You need to be a subscriber to the journal in order to access the paper.
Pandemic flu: Most nursing homes don't have a plan
Less than a quarter of nursing homes in JAMA study have specific pandemic plan
ANN ARBOR, Mich. — If an influenza pandemic hits the United States, acute care hospitals are likely to be overwhelmed. Nursing homes may then be expected to assist with the patient overflow, but a new study in the Journal of the American Medical Association suggests that many are not prepared for such a task.
Of the more than 400 nursing homes in the study, just 23 percent had a specific pandemic influenza plan. Another quarter of the nursing homes had a pandemic response incorporated into an overall disaster response plan. And more than half – 52 percent – did not have any pandemic plan.
"If nursing homes are called upon to serve as alternative care centers for patients who can't be treated in overcrowded hospitals, the impact on the nursing homes could be vast. Nursing homes serve a vulnerable population prone to dire consequences from an emergency," says lead author Philip W. Smith, M.D., professor and chief, Section of Infectious Diseases, University of Nebraska Medical Center. "While most facilities felt that nursing homes were being counted on to take hospital overflow patients in a pandemic, in reality few homes would be able to do so."
Preparedness for Pandemic Influenza in Nursing Homes: A 2-State Survey
Philip W. Smith; Valerie Shostrom; Al Smith; Michael Kaufmann; Lona Mody
JAMA. 2008;300(4):392-394.
EXTRACT | FULL TEXT | PDF
While 48% of the nursing homes answering the survey claim either to have a specific pandemic plan, or to have incorporated a pandemic response into their overall disaster plan - there remains a huge unanswered question.
Are any of these `plans' worth the paper they are printed on?
Frankly, we don't know. No one does, really.
Unfortunately many `plans' are either dangerously optimistic about the impact of a pandemic, or assume the availability of resources or of outside help that simply may not be available during a crisis.
Saying you have a `plan' isn't enough. It needs to be a good plan. It must be realistic, comprehensive, and workable.
I know a lot of people my age who have a retirement plan. Unfortunately, in order to work, it requires they win the lottery.
It's a plan. It just isn't a very good one.
There are hospitals that plan to call on local or State police to beef up their security during a pandemic. To protect their staff, to turn away patients, to do crowd control, and to secure entrances.
It's in their plan.
Of course, if it isn't in their local or state's law enforcement agency's plan, they may run into a wee bit of difficulty.
And of course, many health care facilities plan on ordering supplies during a pandemic wave, just as they do during normal times. Very few are stockpiling PPE's and other supplies in sufficient quantities to last through a pandemic wave.
Given the increased demand for medical supplies during a pandemic, and the anticipated supply chain problems, that may not work out so well, either.
As far as I can tell, no one is cross checking plans.
Each hospital, nursing home, business, government agency, and municipality pretty much devises their own plan. There are templates, and assumptions, published on www.pandemicflu.gov , but no requirement that they be used.
Even among states, the assumptions about attack rates, fatality rates, and the percentage that will require hospitalization vary widely. Some states appear to be planning for a repeat of the mild Asian flu of 1957, while others are assuming a severe 1918 scenario.
Where would you rather live? In a state that overplanned for the next pandemic? Or a state that badly underplanned?
The JAMA press release also states :
Half of the nursing homes in the study had stockpiled some commonly used supplies such as gloves and hand hygiene products. Less than half had provided pandemic education to staff members. Just 6 percent had conducted pandemic influenza outbreak exercise.
Since we have no definitions of what constitutes `stockpiling' (a week's worth? a month? three months?), or what `pandemic education' or pandemic `outbreak exercises' entailed, it's pretty hard to take much comfort from those numbers.
Perhaps even more disturbing is the secrecy under which many of these plans are devised. Access is often restricted to an anointed few. Employees and citizens too often are told the specifics of the plan will be released `when a pandemic threatens'.
I try to take some comfort when I hear that a government, an agency, or a business has a `pandemic plan'. I take it as a sign that they have at least thought about the problem.
But a bad, or unrealistic plan will be of little use during a crisis. A plan that hasn't been rigorously tested, must remain highly suspect. And a plan that remains locked up in a drawer somewhere, out of the public eye, can't be trusted at all.
It is time that companies, health care facilities, and all local governments release their pandemic plans, and ask for input from the citizens and employees that they will affect. Those entities that have no plans should be `outed'.
That might prove to be enough of an incentive to spur them to action.
If the plans are any good, they will withstand the light of day.
If not, there is still time to fix them.
But to assume that simply `having a plan' will be sufficient during a crisis is just nuts.
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