# 3723
Every winter, seasonal influenza sends hundreds of thousands of Americans to Emergency Rooms (ERs) around the country. And every flu season, ERs and hospitals and ICU’s are stressed – sometimes to the breaking point – with this influx of flu patients.
This year, with a novel influenza virus circulating, hospitals fear that unprecedented numbers of people will show up at ERs – the sick, and the worried well – looking for treatment and/or reassurance.
Already, some ERs are having to set up special triage centers, sometimes in tents in the parking lot, in order to handle this surge. And it is only early September.
A couple of articles . . . . then some discussion.
Memphis hospital uses tent as ER for surge of swine flu patients
By Tom Charlier • THE COMMERCIAL APPEAL • September 12, 2009
MEMPHIS — Although Le Bonheur Children's Medical Center is completing a dazzling new $235 million steel-and-glass tower, the most urgent construction project at the hospital Friday night involved erecting a tent straight out of the TV show M*A*S*H.
Le Bonheur set up the 2,400-square-foot tent to handle a growing influx of patients stricken with H1N1 swine-flu virus.
The local influenza outbreak, part of a global pandemic, has more than doubled the patient load at the hospital's emergency room in recent days, even though most of the children don't need to see a doctor, health officials say.
People worried about swine flu swamp Neb. ER
September 12, 2009 9:05 AM ET
OMAHA, Neb. (AP) - Officials at the Nebraska Medical Center say their emergency room has been swamped with sick people concerned about swine flu.
They're reminding the public that most cases of swine flu have been mild, with the sick recovering at home without treatment.
Those who believe they may have swine flu are advised to contact their doctor's office.
These stories are probably going to become far more common as we move deeper into this very early, and active, flu season.
The advice - Those who believe they may have swine flu are advised to contact their doctor's office – for many Americans may prove to be easier said than done.
Of the 40+ million Americans without insurance, many have no family doctor. For these people it is either a walk-in urgent care practice (aka a `Doc-in-a-Box’), which requires cash or a credit card – or the local Emergency room.
While I have insurance, I know from experience that during the winter months (even in a non-pandemic year), I usually can’t get an appointment to see my doctor in less than a week.
Sometimes longer.
This year, with the amount of flu we are likely to see, I’m not at all optimistic that I could get in to see him during the first 48 hours of an illness – when antivirals might be of most benefit.
Even getting through on the phone to my doctor’s office during the winter can be a challenge, due to chronic busy signals. And of course nights and weekends – with the additional filter of an answering service to get past - becomes even more problematic.
The catch-22 in all of this is that doctor’s offices in this country almost universally warn patients – via voice mail recordings before you can talk to a receptionist – that `If this is an emergency, hang up and dial 911 or go to your local Emergency Room.”
If it isn’t an emergency – then they assume you can wait 4 or 5 days for an appointment. Right?
While I certainly don’t want millions of people (including the worried well) clogging up Emergency Rooms around the country this winter, I’m not entirely sure what alternative many of them are going to have.
We’ve done a great deal at the State and Federal levels to prepare for a pandemic, I’ve seen very little being done at the primary care provider level. Most of the doctors I’ve spoken to over the past couple of years have had very little time, or inclination, to think about pandemic issues.
The HHS last week issued `suggestions’ on how GPs might streamline their operations during this flu season, among other things stating that:
Persons at higher risk for complications from influenza or who have already developed severe illness should be treated as quickly as possible after signs or symptoms develop. To reduce delays in starting treatment, health care providers should:
- Provide information for patients at higher risk for influenza complications about signs and symptoms of influenza and need for early treatment after symptom onset when ill with influenza;
- Ensure rapid access to telephone consultation and clinical evaluation for these patients as well as patients who report severe illness;
- Consider empiric treatment of patients at higher risk for influenza complications based on telephone contact if hospitalization is not indicated and if this will substantially reduce delay before treatment is initiated;
- (Continue . . . )
Saying that doctors should Ensure rapid access to telephone consultation sounds good, but I’m not sure how that is going to work.
Most GPs are running behind from the moment they hit the door of their office. This winter, they will probably be even further behind after doing `morning rounds’ for their already hospitalized flu patients.
When they get to their office, they are likely to find their waiting rooms clogged. Finding time to provide telephone `flu’ consults between seeing patients is going to present major challenges.
The nurse has to pull the chart, the doctor has to review it, listen to the patient’s complaints, and decide (sight unseen) if it warrants telling them to go to their local ER, or simply calling in an Rx.
And in our increasingly litigious society, you can bet that if there is any doubt at all, the doctor is going to look out over their already crowded waiting room- think better of it - and tell the patient to go to the ER.
Which puts us pretty much back where we started. With overflowing triage tents in hospital parking lots.
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