The worst-case scenario for our hospitals in a severe pandemic

I wish that I didn’t have the experience of working 34 years as a nurse. I know the big picture in a hospital. A recent article stated that the Twin Cities, where I live, has 500 ICU beds, 450 ventilators. As of last Friday, those were 95 percent full.

Apparently, there are new CDC guidelines stating that healthcare workers can wear surgical masks when N95 masks are not available, but the preference is the N95s. Patients should be placed in single rooms with airborne precautions, and negative pressure rooms should be saved for patients undergoing aerosol-generating procedures. The preference is for wards to be set aside for coronavirus patients.

In a surge, large hospitals would reconfigure to make a lot of their beds for coronavirus patients.  ERs would probably triage people in a different way. If you aren’t seriously ill, you will be sent to a tent outside the hospital, treating the non-coronavirus patients. They will see you, send you to a clinic or admit you to the tent hospital or other facility set up elsewhere. There may be a separate tent set up just for non-serious coronavirus patients.

There are five hundred ICU beds in my metro area of 3.2 million, and that is small in a situation like this.  They would quickly fill up. The 450 ventilators would also be used quickly. Then what? There is a national stockpile of additional ventilators numbering 4,000 to 10,000 depending on who you ask. Great right?

They will quickly be used. They will require more trained staff. Nurses will increase their normal workload exponentially. Old nurse-patient ratios will be out the window.

In the meantime, the National Public Health Service will have deployed medical teams capable of setting up alternative care sites fully functioning hospitals with doctors and nurses.  Apparently, the Federal Emergency Management Agency (FEMA) sends out teams who coordinate the logistics of equipment and supplies.  They probably deploy equipment and supplies from national stockpiles stationed around the country.

The National Disaster Medical System (NDMS) is designed to fill in the gaps in national disasters.  They will deploy their disaster assistance medical teams made up of doctors, nurses, paramedics, EMTs, NP/PAs, etc. along with technical personnel. They will fill in gaps in the healthcare system. The problem is they are intermittent civilian workers with other jobs.

I will speculate about the military role in a pandemic.  I served in the Air National Guard for four years as a flight nurse. The military participates in NDMS exercises along with civilian hospitals.  For example, my aeromedical evacuation unit participated in Minnesota exercises coordinated with local hospitals during the time I served.

Military hospitals would be used in a severe pandemic. They would expand capacity and bring in active duty nurses to supplement. The military has quickly deployable combat support hospitals that could be used. I saw it in the Middle East. Available active-duty nurses, doctors, combat medics could be redirected to staff them. The VA hospitals would expand capacity.

I am sure there will be retired nurses and doctors brought in in a severe situation.

All of this is a worst-case scenario. It is based on my reading and experience. I know it is not complete, and some aspects may be different than I wrote. Let’s hope we don’t get to this point.

Susan Shannon is a retired nurse who blogs at madness: tales of a retired emergency room nurse.

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