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Pandemic Influenza Triage in the Clinical Setting

Published online by Cambridge University Press:  28 June 2012

Steven J. Rottman ,
Kimberley I. Shoaf ,
Jennifer Schlesinger ,
Eva Klein Selski ,
Joey Perman ,
Kerry Lamb  and
Janet Cheng
Steven J. Rottman*
Affiliation:
University of California Los Angeles Center for Public Health and Disasters, Los Angeles, California USA David Geffen School of Medicine, University of California Los Angeles Center for Public Health and Disasters, Los Angeles, California USA
Kimberley I. Shoaf
Affiliation:
University of California Los Angeles Center for Public Health and Disasters, Los Angeles, California USA
Jennifer Schlesinger
Affiliation:
University of California Los Angeles Center for Public Health and Disasters, Los Angeles, California USA
Eva Klein Selski
Affiliation:
University of California Los Angeles Center for Public Health and Disasters, Los Angeles, California USA
Joey Perman
Affiliation:
University of California Los Angeles Center for Public Health and Disasters, Los Angeles, California USA
Kerry Lamb
Affiliation:
University of California Los Angeles Center for Public Health and Disasters, Los Angeles, California USA
Janet Cheng
Affiliation:
University of California Los Angeles Center for Public Health and Disasters, Los Angeles, California USA
*
Adj. Professor Emergency Medicine and Community Health Sciences David Geffen School of Medicine and UCLA School of Public Health Director, UCLA Center for Public Health and Disasters 1145 Gayley Avenue Suite 304 Los Angeles, California 90024 USA E-mail: rottman@ucla.edu
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Abstract

Introduction:

There has been much federal and local health planning for an influenza pandemic in the United States, but little is known about the ability of the clinical community to deal quickly and effectively with a potentially overwhelming surge of pandemic influenza patients.

Problem:

The attitudes and expectations of emergency physicians, emergency nurses, hospital nursing supervisors, hospital administrators, and infection control personnel concerning clinical care in a pandemic were assessed.

Methods:

Key informant structured interviews of 46 respondents from 34 randomly selected emergency receiving hospitals in Los Angeles County were conducted using an Institutional Review Board-approved protocol. The interview asked about supplies/resources, triage, quality of care, and decision-making. At the conclusion of each interview, the informant was asked to provide the contact information for at least two others within their respective professional group. Interviews were transcribed and coded for key themes using qualitative analytical software.

Results:

There was little salience that an influx of variably ill patients with influenza would force stratified healthcare decision-making. There also was a general lack of preparation to address the ethics and practices of triaging patients in the clinical setting of a pandemic.

Conclusions:

Guidelines must be developed in concert with public health, medical society, and legislative authorities to help clinicians define, adopt, and communicate to the public those practice standards that will be followed in a mass population, infectious disease emergency.

Keywords

emergency triageethicspandemic influenzastandards of care
Type
Research Article
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 2 , April 2010 , pp. 99 - 104
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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References

1.World Health Organization Epidemic and Pandemic Alert and Response: Avian influenza frequently asked questions. Available at http://www.who.int/csr/disease/avian_influenza/avian_faqs/en. Accessed 25 August 2008.Google Scholar
2.UN Food and Agriculture Organization: Bird flu situation in Indonesia critical. Available at http://www.fao.org/newsroom/en/news/2008/1000813/index.html. Accessed 25 August 2008.Google Scholar
3. Osterholm, MT: Preparing for the next pandemic. N Eng J Med 2005;352:1839–1842.CrossRefGoogle ScholarPubMed
4.American Hospital Association: The 2007 state of America's hospitals—Taking the pulse. Findings from the 2007 AHA Survey of Hospital Leaders, July 2007. Available at http://www.aha.org/aha/content/2007/PowerPoint/StateofHospitalsChartPack2007.ppt. Accessed 25 August 2008.Google Scholar
5.(US) Department of Health and Human Services: HHS pandemic influenza Plan. Part 1: Strategic plan. Planning assumptions. Available at http://www.hhs.gov/pandemicflu/plan/part1.html. Accessed 25 August 2008.Google Scholar
6.Community strategy for pandemic influenza mitigation, February 2007. V. Use of nonpharmaceutical interventions by severity category. Available at http://www.pandemicflu.gov/plan/community/commitigation.html#V. Accessed 25 August 2008.Google Scholar
7.American College of Emergency Physicians: EMTALA. Available at http://www.acep.org/patients.aspx?id=25936. Accessed 25 August 2008.Google Scholar
8. Gostin, LO: Medical countermeasures for pandemic influenza: Ethics and the law. JAMA 295:554–556.CrossRefGoogle Scholar
9.State Pandemic Plans. Available at http://www.pandemicflu.gov/plan/states/stateplans.html. Accessed 25 August 2008.Google Scholar
10.Hospital Pandemic Influenza Planning Checklist. Available at http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.html. Accessed 25 August 2008.Google Scholar
11. United States General Accounting Office: Influenza pandemic: Plan needed for federal and state response. Available at http://www.gao.gov/new.items/d014.pdf. Accessed 25 August 2008.Google Scholar
12. DHHS: Draft Pandemic influenza response and preparedness plan. Available at http://www.hhs.gov/news/press/2004pres/20040826.html. Accessed 25 August 2008.Google Scholar
13.National Strategy for Pandemic Influenza. Available at http://www.white-house.gov/homeland/pandemic-influenza.html. Accessed 25 August 2008.Google Scholar
14.National Strategy for Pandemic Influenza: Implementation plan. Available at http://www.whitehouse.gov/homeland/nspi_implementation.pdf. Accessed 25 August 2008.Google Scholar
15.County of Los Angeles Department of Health Services: Hospital pandemic influenza guidelines for acute care hospital settings. Available at http://www.lapublichealth.org/acd/docs/Flu/acute%20care%20hospital%20pan%20flu%20plan%203.1.06.pdf. Accessed 25 August 2008.Google Scholar
16.DHHS Pandemic Planning. Available at http://www.pandemicflu.gov/plan/pdf/panflu20060313.pdf. Accessed 25 August 2008.Google Scholar
17.DHHS: HHS announces $896.7 million in funding to states for public health preparedness and emergency response. Available at http://www.hhs.gov/news/press/2007pres/07/pr20070717c.html. Accessed 25 August 2008.Google Scholar
18. Burt, CW, McCaig, LF, Valverde, RH: Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med 2006;47(4):317–326.CrossRefGoogle ScholarPubMed
19. Sun, BC, Mohanty, SA, Weiss, R, et al: Effects of hospital closures and hospital characteristics on emergency department ambulance diversions, Los Angeles County, 1998-2004. Ann Emerg Med 2006;47(4):309–316.CrossRefGoogle Scholar
20. Institute of Medicine of the National Academies: Future of Emergency Care. Hospital-based Emergency Care at the Breaking Point. 2007. Washington, DC: The National Academies Press, 2007, p 38.Google Scholar
21. American Hospital Association: Emergency departments—An essential access point to care. Available at http://www.aha.org/aha/trendwatch/2001/twmarch2001.pdf. Accessed 25 August 2008.Google Scholar
22.Hospital Closures in California 1996 to Present as of September 2006. Available at http://www.calhealth.org/public/press/Article%5C107%5CHospitalclosures.pdf. Accessed 25 August 2008.Google Scholar
23.Estimated Population of Los Angeles County as of January 1, 1991- January 1, 2007. Available at http://www.laalmanac.com/population/po04.htm. Accessed 25 August 2008.Google Scholar
24. University of California San Fransisco News Office: California's nursing shortage crisis will vary by region, UCSF report shows. Available at http://pub.ucsf.edu/newsservices/releases/200608229/. Accessed 25 August 2008.Google Scholar
25. American Association of Colleges of Nursing: Nursing shortage. Available at http://www.aacn.nche.edu/media/FactSheets/NursingShortage.htm. Accessed 25 August 2008.Google Scholar
26. Devereaux, A, Christian, MD, Dichter, JR, et al: Summary of suggestions from the Task Force for Mass Critical Care Summit, January 26-27, 2007. Chest 2008;133:1S–7.CrossRefGoogle ScholarPubMed
27. Thomas, M: Ethical Issues in Pandemic Response. American Public Health Association Annual Meeting. November 2006. Boston, MA.Google Scholar
28. Thomas, M: Ethics of Altered Standards of Care. 6th UCLA Conference on Public Health and Disasters. 07 May 2007, Torrance, CA.Google Scholar