Influenza may pose problems for hospital emergency departments this fall. The pandemic H1N1 influenza virus has circulated at low levels in the U.S. this summer. But as the normal flu season arrives, schools will open and people will be in enclosed spaces. The flu attack rate will increase, sending more people for care, often to the emergency departments of hospitals.
Depending on the severity of flu spread in the community, multiple flu patients could saturate emergency departments. This impairs the ability of the emergency department to treat other cases, such as heart attacks and car accidents. As emergency departments fill with flu patients, waiting times will become lengthy.
Additionally, the risk of infection of the non-flu patients is high. Flu patients must wear masks and be in separate waiting areas. A subset of flu patients will need to be admitted for complications of the flu. As hospitals typically function with 80 to 90 percent full beds, the ability to absorb these additional cases is limited.
To avoid overloading hospital emergency departments, several approaches are important. Clinics and individual doctor’s offices should provide extended hours. The ability to screen patients can be bolstered by the use of “flu clinics.” These could be at hospitals or set up on a regional basis. These clinics would screen flu patients for complications requiring hospital admission and allow the vast majority of people to be discharged to home care.
Most people require only supportive home care for influenza. This includes adequate fluids to avoid dehydration, acetaminophen or ibuprofen for fever, and rest.
A higher level of influenza cases causing severe hospital overload would require more drastic measures. The conversion of beds used for outpatient procedures (such as cardiac catheterizations) will allow the admission of additional patients. Cancelling non-emergency surgeries will free up beds (but patients will not get their needed surgeries). Successful use of these tactics will be difficult with the projected hospital staff shortages due to the flu.
If regional hospital bed shortages were to further worsen, and beds become unavailable, alternate care facilities will need to be opened. These may be opened by hospitals or regional governments. These improvised hospitals will provide care for less sick patients. These facilities will need to be staffed in part by family members and volunteers.
The impact of pandemic influenza on the region this fall and winter cannot be predicted. Therefore the health care system must plan for a wide range of possibilities, from a mild to severe flu season.
The support of a knowledgeable and prepared public will help ensure the health care system can continue to meet the needs of the public.
Charles Little is an associate professor in the division of emergency medicine at the University of Colorado Denver School of Medicine.
