A year since we first started to come out with the numbers, there are still no reliable estimates, or even attempts to derive them, as far as I can tell, of the US ICU surge capacity. And this information is more critical now than ever, as we are faced with the potential for untold numbers of H1N1-related hospitalizations accompanied by severe respiratory failure. It is shocking to me that we are leaving these infrastructure issues to chance.
But wait, why am I so shocked? This is just another byproduct of our fragmented healthcare "system". There is no one either to take or to designate responsibility for planning. While our professional organizations are doing the best they can, their approach is usually siloed and somewhat distracted: in case you have not heard, we are also tackling the most rampant pandemic of antibiotic resistant infections, which affects ICUs disproportionately.
So, who will take charge of this hot potato? The CDC? Homeland Security? FEMA (chuckle-chuckle)? Press your representatives to tackle this thorny issue, because if you are worried about planned rationing now, wait until you see what unplanned bedlam looks like. Condi Rice said that the US intelligence community just did not have the imagination necessary to anticipate the 9/11 terrorist attack. Let us not have to resurrect this tired excuse this flu season.
I strongly agree. It has been obvious for several years in the UK that the ICUs are run at such a high capacity that there is no slack in the system for eventualities such as flu pandemics and that the numbers are even worse for our PICUs.
ReplyDeleteWe are already seeing problems with ICU availability in the UK and we are probably only in the early stages of this pandemic.
It should be easier for us because of the NHS but the fragmentation across Primary Care Trusts and other Health Authorities plus the lack of appropriate liaison with relevant authorities.
Thanks, Evidence! Yes, the issue of ICU capacity is enormous! I hope that we can learn from some of the lessons of the Southern hemisphere as their flu season progresses.
ReplyDeleteI discovered your paper on ICU utilisation when I was trying to find stats about the number of ICU beds in the US compared to other countries for my blog post on H1N1, ICU utilisation, and EMTALA: http://theoctopustrap.blogspot.com/2009/07/reform-rationing-swine-flu-and-futile.html
ReplyDeleteAs for getting an ICU bed; two weeks ago I had to beg and transfer patients 30 miles across town (Australia's largest city); more recently it's been tight but not impossible.
DHS, thanks for your comment! I think that we need to learn from the Aussie experience, and I do not believe that we will be prepared without a serious coordinated effort.
ReplyDeleteAs for comparative bed numbers, you might check out the work of my colleague Hannah Wunsch -- she has done some of that research.