State of Utah

• 9 pages
• Public Safety Sensitive
• November 6, 2006

Executive Summary:

Issue: A pandemic will severely stress and overwhelm the capacity of our current health care system to provide and sustain care for those who need it. This includes those inside the health care system, such as: hospital and health clinic employees, home health agencies, private physician groups and other medical facilities. Fire, EMS and other responding agencies, local and state health department personnel will also be affected.

Recommendations for the Taskforce:

1. Establish mechanisms to establish altered standards of care for use during a pandemic and to provide liability protection to providers following those altered standards of care

a. Build upon the pandemic decision-making process recommended by the Taskforce previously, to develop altered standards of care based on a “sufficiency of care”1 model for implementation during a pandemic when usual care was not possible.

b. Endorse the development of legislation that would protect health care facilities and emergency response personnel from legal action for using the “sufficiency of care” model when the recommendation is made to do so and develop ready-to-use emergency declarations to facilitate needed actions and decisions.

2. Support the development of unified messages from hospitals, the Utah Department of Health and local health departments, informing the public that care given at hospitals during a pandemic event will be different than the care they receive today; including clear messages about who should and should not report to health care facilities during a pandemic.

3. Encourage community support for our health care providers so they can continue to care for their families while still coming to work. Support may include priority for prophylactic medication and or vaccination for themselves as well as their families and assistance with procurement of essential supplies. Develop an educational process for the public on how the flu is spread and what they can do to protect themselves; explaining the importance of hand and respiratory hygiene and social distancing.

4. Recommend healthcare systems purchase and stockpile essential supplies. This may include preparedness items such as: personal protective equipment (PPE), automatic resuscitators, N-95 respirators, cots and body bags. Additionally, recommend that hospitals are supported financially to ensure planning and preparation is completed.

5. Support the use of willing medical and non-medical volunteers to provide care outside of their expertise by providing unified training for those who agree to do so.

Background:

Utah’s current healthcare situation:

The Utah Hospital Association (UHA) performed a hospital survey in the spring of 2006 focusing on current available resources. The results of the survey revealed the state has 4,915 licensed beds. However, only 3,949 of those beds are currently staffed. This is due to a chronic shortage of qualified physicians, nurses, pharmacists and respiratory therapists available to staff those beds. Many of the hospitals in our state run at 90% capacity or higher on a daily basis. Emergency Departments are particularly stressed; not just in Utah but all over the United States. The Institute of Medicine’s Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S., to create a vision for the future of emergency care, including trauma care, and to make recommendations to help the nation achieve that vision. Their findings were published in June 2006 and revealed that demand for emergency care has been growing fast; emergency department visits grew by 26 percent between 1993 and 2003 but over the same period, the number of emergency departments declined by 425 and the number of staffed hospital beds declined by 198,000. Please see the supporting document for projected numbers of persons per county that would be affected during a pandemic event.

Pandemic Planning assumptions:

• The clinical disease attack rate will likely be 30% or higher in the overall population during the pandemic.

• Of those who become ill with influenza, 50% will seek outpatient medical care.

• In a severe pandemic, absenteeism attributable to illness, the need to care for ill family members and fear of infection may reach 40% in health care workers during the peak weeks of a community outbreak.

• In an affected community, a pandemic outbreak will last about 6 to 8 weeks.

• Multiple waves of illness could occur.

• There is no vaccine and it will take approximately 6 months to develop one after the pandemic has started.

Objectives:

1) Develop a realistic understanding of the capacity of the health care system to respond to a pandemic and identify measures and options that can be taken to improve that capacity.

2) Identify measures that can be taken to improve public awareness and adherence to health messages in order to use the system optimally.

3) Identify measures that can be taken to protect health care workers and to preserve the ability of the health care system to function during and after a pandemic.

4) Identify measures to protect hospitals and health care providers from the consequences of a pandemic, including liability from providing care when it is not possible to meet usual standards of care.

5) Identify decisions that should be referred to the pandemic decision-making process recommended previously by the Taskforce.

…

C. Lack of Funding:

Hospitals that have increased their medical equipment and supplies have done so at their own cost. Most hospitals in Utah do not have a full time person devoted to disaster planning due to lack of funding for this position. Currently, the UHA has identified three critical areas where lack of funding has a direct affect on the inability to meet patient demand with current resources:

I. Beds – The State of Utah regulations allow for an automatic 20% increase in licensed bed capacity in an emergency situation such as pandemic influenza, the critical issue remains finding staff to care for the patients placed in those beds. An additional consideration is the physical location for those beds. Placement of patients in non-traditional areas within the hospital or in alternate care facilities not attached to the hospitals, utilizing volunteers to provide staffing for these additional beds, would require legislative protection and funding for training. The use of screening areas and readily available screening tools used to quickly evaluate patients seeking care; sending the least sick home and those with the highest probability of survival to any facility with an open bed would require funding for training, equipment and supplies.

II. Staffing – Most hospitals and health clinics are working at or near staffing capacity on a daily basis, some turning away patients because they don’t have the staff to take care of them. The lack of qualified health care professionals has made it difficult to find additional staffing for day to day operations, let alone during a pandemic event. Additionally, health care providers will have the highest risk for contracting the flu. Many are fearful that they will take the flu home to their family, for this reason there is the potential for decrease in available workforce to be even higher than in the non-healthcare workplace. Retaining support staff such as house keeping is also a major concern. Some support services may be even more unlikely to report to work than physicians, nurses, pharmacists, and respiratory therapists.

III. Medical Equipment and Supplies – Currently, most facilities use a “just-in-time” inventory and have no protocols in place to stockpile supplies such as: large numbers of N-95 respirators, masks, gowns and gloves that would be needed during a pandemic. Utah hospitals who are trying to stockpile supplies are having a difficult time purchasing these supplies (N-95 respirators and masks) due to high volume orders being placed all over the country. Purchase of larger equipment such as ventilators is questionable because of cost ($27,000 per ventilator) and lack of highly trained staff required to care for a patient on a ventilator.

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