ACEP unveils plan to manage fall pandemic wave

Lisa Schnirring * Staff Writer
Jul 6, 2009 (CIDRAP News)

The American College of Emergency Physicians (ACEP) recently released a plan
to help emergency departments, first responders, and public health
departments manage a surge in pandemic flu cases that many experts predict
will happen this fall.

The 16-page plan was produced under a contract with the US Department of
Health and Human Services (HHS) office of the Assistant Secretary for
Preparedness and Response (ASPR) and its Emergency Care Coordination Center,
ACEP said today in a press release. The document defines critical
capabilities and suggests ways to achieve them, ACEP said.

"While H1N1's virulence is not predictable, it is expected to be highly
contagious and will place added strains on the emergency care system," said
Nicholas Jouriles, MD, president of the ACEP, in the statement.

He added that planning for a second wave will be successful only with
cooperation between first responders and public health officials. The plan
urges local ACEP chapters to enlist support from state and local health
directors, local emergency managers, and political leaders for emergency
planning efforts.

The main components of the plan, based on the federal template for managing
biological threats, include situational awareness, protecting emergency
department infrastructure and personnel, preventing service disruptions,
organizing a timely surge response, and recovering to the previous status.
Communications with local and state public health officials are crucial, and
it's important to have agreements in place for the "triggers" authorities
will use to "stand down" the pandemic plan, according to the document.

One of ACEP's key planning assumptions is that large volumes of vaccine
against the novel H1N1 virus probably won't be available until mid October
at the earliest and that the public won't be protected from infections until
2 weeks after a second injection.

As a result, if the second pandemic wave begins September, health officials
may depend heavily on community mitigation strategies to slow the spread of
the virus. Emergency departments will still face a surge of patients, but
interventions such as school closures will likely strain the department
workforces even further, the ACEP plan warns.

Social distancing measures will also affect critical infrastructure
businesses and institutions, which may slow the flow of transportation and
supplies. Emergency planners shouldn't assume that antiviral medications
will be effective for a virus that may have undergone selection pressure
between waves, the report notes.

"While the precise effects on emergency departments to function cannot be
predicted with confidence, contingency plans should be made for a
challenging scenario," the plan states.

The nation's economic problems and the importance of staying on the job may
add to the pressures to keep schools open, the planners wrote. News reports
of deaths in young people, an age-group currently bearing the brunt of
illnesses, might fuel even more parents to seek medical care for their

The plan includes 27 capabilities for emergency department response to a
severe novel H1N1 outbreak, each with suggested steps and an outline for
what level of health or government group is responsible. For example, the
plan covers personal protective equipment stockpiling, facility security,
crowd management, alternate locations for triage and screening, and
configuring waiting rooms for social distancing, if possible.

Stephen Cantrill, MD, an emergency department physician in Denver and a
member of ACEP's clinical policy committee, told CIDRAP News that the novel
influenza plan is also designed to raise awareness among emergency
physicians. The potential burdens will be vast, he said, not only for
keeping the workforce functioning during the surge, but also keeping
departments adequately supplied.

"There are so many vulnerabilities in the supply chain, where do you start?"
he asked, adding that even departments that are well prepared might not able
to sustain their supplies.

The impact of the influenza pandemic on emergency departments will be
affected greatly by how local public health officials craft their messages
to the public, Cantrill said. He said the US Centers for Disease Control and
Prevention (CDC) has done a good job communicating flu facts to the public,
including details on when to seek medical care.

James M. Wilson V, MD
Chief Technical Officer and Chief Scientist
Veratect Corporation
Kirkland, Washington
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