US Panflu Update - 11/12/09 "Are we in the clear yet???"

US Pandemic Situation Report- Nov 12th

The overall national trend is now one of declining impact. Reporting nationwide continues to be highly variable from location to location. Some locations are reporting decreases in case loads while others are reporting dramatic surge. The below information pertains to those locations within the US reporting challenges related to pH1N1.

School Absenteeism

Student absenteeism rate (elementary and high school): 10-40% (10-20% usual range reported)
Teacher absenteeism rate (elementary and high school): not specified but still documented

Local Medical Infrastructure

EDs and outpatient clinics continue to be overwhelmed by anxious well and truly ill patients.

EMS and first responders report no appreciable impairment in operations reported.

Hospital ward level inundations have been reported. Excession of capacity was not noted since last report. Healthcare worker absenteeism has contributed to strain.

ICU capacity has been reported to approach near- to at-capacity. Demand for ECMO or HFOV continues to be observed.

San Joaquin County, California declared a local state of emergency due to broad medical infrastructure strain.

Mortuary services have not reported strain.

Fewer people are donating blood in the United States due to the pandemic. In addition, some blood centers nationwide have had to throw out blood donations after learning that the donor had influenza-like symptoms. Although the centers claim that they have sufficient blood supplies now, a further decrease in blood donations, particularly during the Christmas season, is a concern.

General Infrastructure Strain

Main sectors affected this week include primarily education, public health, and medical care. Government and corporate sectors have not reported strain since last report.

A pork producer from Clinton, North Carolina filed for bankruptcy after owing about USD three million to various vendors. The company, Coharie Farms, blames the loss on an increase in grain prices, a decrease in hog prices, and pandemic (H1N1) 2009 "fears". The owner of Coharie Farms plans to liquidate the company and "some" of the 170 employees will be laid off. The company lost about 17 million dollars this year. Coharie Farms is the largest independent pork supplier to Smithfield Foods Company. North Carolina has the second largest pork industry in the United States.

Social Anxiety

Frustration and anxiety associated with failure of meeting expected public access to pandemic vaccine and public perception of uneven distribution of vaccine to priority groups has become the primary focus for public anxiety. This relates to public outcry due to a perception of politicians and other non medical-risk groups observed to be vaccinated ahead of those groups identified and publicized by CDC for vaccine priority.

Worried well influx to emergency departments and parents keeping well children home from school continues to be documented. Limited instances of parents refusing vaccination after reports of adverse vaccine reactions (regardless of credible proof the vaccine was the cause of the reaction) continue to be documented.

The current focus for social tension revolves around vaccine availability and uneven distribution.

In addition to strain and anxiety, medical staff are dealing with threats, insults, and bribes from patients. Doctors are compelled to reassure patients that they are waiting their turns for the vaccine and not prescribing Tamiflu for themselves or their families unless necessary. Two vaccine clinics in New York were canceled after parents began to threaten nurses. According to staff members, one parent stated that he would "hunt down" the nurse if anything happened to his child while another parent threatened to sue a nurse if something happened to his child.

Primary triggers for social outcry and anxiety behavior continue to be 1) the death of children or 2) pregnant mothers in a community. Publicly perceived violation of expectation regarding availability (and now) distribution of pandemic vaccine has become a prominent driver of social anxiety.

Environmental Conditions

Environmental conditions are currently moderately optimized for transmission throughout the majority of the US and are projected to optimize fully within the next 3 months.

Expected Progression

While national epidemiological statistics indicate a past peak and decline in cases, high variability in local experience is still observed. Overall national impact is declining.

Pandemic H1N1 is expected to continue to strain local medical capacity, however now at lower levels. Variables in local transmission include herd immunity levels achieved through prior community exposure to the virus, public and healthcare worker uptake of pandemic vaccine, and virus genetic stability.

Veratect's West and East Coast Operations Centers remain vigilant for possible resurgence following mass mixing events such as Thanksgiving and especially the Christmas / New Year's holiday seasons. It is unclear to what degree the pandemic will impact social functioning when environmental conditions are maximally optimized in January-February. Veratect remains vigilant for reporting of virus drift or recombination.

 James M. Wilson V, MD
Chief Technical Officer and Chief Scientist
Veratect Corporation
Kirkland, Washington
571.225.3671
jim@veratect. com

CAMTS Accreditation - Blessing or Curse?

NOTE: This is my commentary/response to the original article which appears at:

VerticleOnline and published Oct 21, 2009

MY COMMENTARY:

CAMTS accreditation has become double edged sword.

On one hand your HEMS program may not be able to live without it (either by regulatory requirement of your state, OR by lost revenue via third party insurers who require accreditation), but on the other it may be hard to live WITH it too! -recurring site visits, 3 year applications for reverification, continually updating standards etc.

One of the big problems with CAMTS accreditation is that in some circles it is legislatively mandated (see the 8 states that require it) and by definition, accreditation conflicts with "mandatory" -- so which is it? Mandatory or voluntary???

Personally I believe the original intent of CAMTS was good for the following reasons:

1) It's not governmental: for those of us who dislike big brother running everything. (This is a HUGE plus in my book)

2) Technically, it's still voluntary (debatable)

3) Nursing/carregivers: involvement with heavy focus on requirements for the medical crews, in my opinion, is good. I believe the industry is moving towards recognizing the medical crews as AIRCREWS. I think there will be needed discussion when/if this happens (I hope it does) because then there is more FAA oversight in that aspect.

4) CAMTS uses widespread representation. Argue if you like about how the pilots are not as strongly represented, but there are a few other "non-specific" seats on the CAMTS board of directors which could be occupied by qualified pilots as well.

---->NOTE: if the HEMS pilots do not feel they are represented adequately by CAMTS, then they should lobby their professional organizations to develop some type of accreditation program as well, OR, get their representative body to work more collaboratively and intertwined with CAMTS

5) In my personal opinion, in what I have read and researched over the years, I feel CAMTS strives to stay "ahead of the curve" in as much as incorporating or leaning towards industry leading "best practices" as well as those practices which may be recommendations by federal investigative/review committees. I have always felt that CAMTS was dynamic and responsive to the HEMS community.

I realize there are more problems and concerns with CAMTS which I have not listed here; I will look for part two of this article to help stimulate more discussion.

My bottom line however, is directed towards the skeptics and nay-sayers.. and I say to those that are (1) unhappy, (2) dis-enfranchised or (3) mis-represented by CAMTS - "sorry", CAMTS has ONLY become so influential and powerful by the VOLUNTARY submission to it's program requirements and accreditation processes by programs across the US... The more programs that seek the CAMTS "Merit Badge", give the CAMTS machine more influence, power and presence....

National Emergency Nurses Week Oct 11-17, 2009

Emergency Nurses "Prepared for the Unexpected"

Emergency nurses across the US will be celebrating Emergency Nurses Week, Oct. 11-17, and Emergency Nurses Day on Oct. 14. This year’s theme is "Prepared for the Unexpected," a perfect theme as every day brings the unexpected. There is no "usual" or "typical" day in an emergency department.

Emergency patients are just that — emergencies requiring acute, episodic care. We care for patients across the lifespan, with a vast range of problems. It is not uncommon to care for a two-year-old boy with a fever, a 75-year-old woman with a fractured hip and a 22-year-old man involved in a car crash, all in the same hour.

We are frontline health care providers, often a person’s first and only interaction with the health care system. Every day, we interact with other disciplines — including physicians, paramedics, respiratory therapists and police officers. We do not work alone, but as part of the health care team, relying on each other’s skill and expertise. Each day, we touch people’s lives, from providing CPR, to explaining the signs of infection to a mother whose child just received stitches for the first time. We are there for our patients and families during happy and sad times — we are also there for each other.

We need to acknowledge the great work done by all our emergency nurses across the US. We are truly a unique specialty, caring for a multitude of diseases and injuries from infancy to adulthood. Every day, we are faced with increased demands, from violent patients, short staffing to overcrowding, but we do our best to provide safe and competent care.

*****
Since 1989, the Emergency Nurses Association has celebrated the second Wednesday in October as Emergency Nurses Day, a day set aside to honor emergency nurses for their commitment to patient care. Starting in 2001, ENA expanded the celebration to devote an entire week to honoring emergency nurses, because it was felt that one day was not enough to recognize all contributions made my emergency nurses.

ENA is the only professional nursing association dedicated to defining the future of emergency nursing and emergency care through advocacy, expertise, innovation, and leadership. Founded in 1970, ENA serves as the voice of more than 36,000 members and their patients through research, publications, professional development, injury prevention and patient education.

ENA General Assembly Day #1 - Town Hall Report

Day #1 of the ENA General Assembly (GA) finished up with a Town Hall style meeting. This is an activity which has been done at the last several ENA GAs and has continued since. It is an opportunity for members to meet in a collegial and informal setting and ask quetions and engage in an "open forum" with the ENA leadership. This provides an opportunity for members to directly ask questions or discuss ideas with the leaders in a setting in which they might not otherwise be able to so easily. Each town hall meeting has several ENA leaders and members of the board present.

The town hall meeting Wednesday evening went quite well. Participation was good and there were approximately 40-50 members present to share.

Some of the topics/items shared are presented here...

One member brought up discussion that they were having a hard time getting "buy in" on TNCC education at her small community hospital because they aren't a "trauma" center and apparently the adminstration felt that they didn't need "trauma" education.

The presenter aknowledged that TNCC was an outstanding course that taught good ED nursing skills as far as patient assessment. Members of the ENA board and those involved with TNCC development responded. They said they understood the point and suggested that this person try to promote TNCC education from the standpoint that a lot of trauma doens't come into the ED by EMS/prehospital, but also by private vehicle or "walk in". As such, it seems that "trauma" education even in the non-trauma centers is definitely of benefit. There was no indication that the naming of the TNCC product was going to be changed, but that maybe a strategy for marketing it differently to address the broader needs of all EDs.

Another question was presented regarding the newest BCEN certification, the CPEN (Certified Pediatric Emergency Nurse). It was pointed out that the CPEN is the only BCEN credential which includes a clinical practice requirement in order to sit for the exam. Currently the other BCEN credentials do not have this (CEN, CTRN, CFRN). The question was asked as to why this practice requirement was made and if in the future, the other credentials would move to include a clinical requirement also.

The response was that the CPEN was developed in conjunction with the Pediatric Nursing Certification Board (PNCB). The joint venture was necessary to establish core content and competencies and as such necessitated the CPEN mirror the pre-existing clinical practice requirement of the PNCB.

So basically the CPEN is a "joint-certification" and shares similarity with PNCB. The other BCEN credentials (CEN, CFRN, CTRN) are unique to BCEN and share no joint development with other certifying boards.

Finally a member from California ENA brought up for discussion that in her state they were having a new mandate from their state legislation. AB 911 mandates that the EDs use a matematical formula to calculate how "full" or "busy" they are with high acuity patients. The presenter discussed how they are not sure how these numbers are going to be used but they are having to dedicate resources to fulfilling this obligation. There was also concern that this mandated a certain softward package or method to do this. Another speaker, also from California, stated that she felt it was a useful tool because part of the calculation was taking into account some patient/system acuity beyond just the ED as it includes numbers of ventilators available etc.

The ENA town hall board responded that they were not as familiar with this recent legislative madate, but would keep their eyes on it in the future. It was stressed to the attendees that this was an example of needing to keep active on the legisltative forefront via our ENA's support structure.

Conclusion:
The town hall meeting ran up until the end of time and probably would have gone on longer if there was not a time constraint.

This author has attended the GA Town Hall meeting for th past 4 GAs. I have always appreciated the venue and felt that it was beneficial. It's a nice forum to get a "direct line" to the people with answers or to get referred to those who may be able to help more. It has always been open, informal and a good use of time.

I'm going to suggest to the ENA conference committe that we continue this forum, maybe even to have it repeated on one of the days of the "reguular" conference too, or to extend the time to 90 minutes or so because there has always seemed to be more topics pending that people wanted to discuss.

ENA Conference/General Assembly Opening in Baltimore

Wednesday October 7.
8:00am

ENA president Bill Briggs called the General Assembly to order for 2010 here in Baltimore MD.
Many new and interesting things were on tap for starters.

One of the first "improvements" was the installation of a new method for registering keypads for the delegates to vote with. Previous years had seen difficulties with delegate registration, missing keypads, DUPLICATE keypads, keypads being "swapped" etc. So it was with a bit of trepidation that we installed a new vendor/service for this and a new process for registering keypads. Overall it seems to be like a good system and some inefficiencies since last year have been improved upon... so far. ...we'll see!

The second part of the morning session saw some emotional debate and speaking regarding one of the new proposed bylaws which is going to effectively "cap" the number of delegates to the general assembly.

This had been proposed by ENA leadership for several reasons, one of which was a financial concern in that larger and larger delegate assemblies was becoming a logistical chore, as well as expenses to the organization were increasing as well. The ENA leadership had proposed a fixed number of delegates and each state would be awarded a respective percentage based upon their annual membership.

Good --- Bad???

Much discourse was had throughout the assembly, many people voiced their opinions both for and against. Some of the larger states voiced concerns that their representation might be diluted by the smaller states getting their "guaranteed" delegates based on small ENA member rolls. Other speakers voiced concerns about the principles of "grassroots", "membership driven" as their speaking points and they advocated for the current method using arbitrary ratios, such as is the current case.

The discussion went on and nearly ran into lunch time and discussion had to be halted temporarily.

As for this author, I am not completely convinced on my own stance on this. I understand the need to limit some of the expenses and the ever increasing logistical burden, however I also understand that, as a "pure" representative organization that is growing, a stable delegate:member ratio, despite increasing numbers, has it's benefits also.

Will be interesting to see how this one pans out.

Seasonal Flu Myths

In the spirit of the upcoming flu season I decided to share with my followers this list of common misunderstandings and misperceptions of the seasonal flu vaccine. An alarming 50% of healthcare workers do not get the flu vaccine annually and some of these myths are the reasons I've heard of before...

Flu Myth #1: The seasonal flu vaccine protects against swine flu. Unfortunately, it doesn’t. The swine flu virus that first appeared in Mexico during April 2009 is a different strain of influenza virus. There is no vaccine for it. So even if you got a flu vaccine earlier this season, it won’t offer any protection against swine influenza.

Flu Myth #2: The seasonal flu is annoying but harmless. There has been a lot of focus on swine flu, but it’s important to remember that the run-of-the-mill seasonal flu can be a serious condition itself. “A lot of people just think of the flu as a very bad cold,” says Curtis Allen, a spokesman for the CDC in Atlanta. But it’s much worse than that. For one, you usually feel terrible. In addition to the congest ion and cough, you’re apt to have nasty body aches and fever, which are less likely with a garden-variety cold. “When you get the flu, you know it,” says Christine Hay, MD, assistant professor at the University of Rochester Medical Center. “You feel like you’ve been hit by a Mack truck.” Aside from the short-term misery and lost workdays, flu can have more serious implications. Sure, most people who get the seasonal flu recover just fine. But the seasonal flu also hospitalizes 200,000 people in the U.S. each year. It kills about 36,000. That’s close to the number of women killed by breast cancer each year, and more than twice the number of people killed by AIDS.

Flu Myth #3: Swine flu is transmitted by pork products. Lots of people have reacted to the swine flu outbreaks by swearing off bacon – just as some countries reacted by banning pork or slaughtering pigs. But experts say that despite the name, there’s no reason to worry about pork products spreading swine flu. Though the virus did originate in pigs, it’s now jumped to people. Since then, the spread has been from person to person, not from pork to person.

Flu Myth #4: The flu vaccine can give you the flu. This is the flu myth most likely to drive experts bonkers. “There is simply no way that the flu vaccine can give you the flu,” says Hay. “It’s impossible.” Why? For one, injected flu vaccines only contain dead virus, and a dead virus is, well, dead: it can’t infect you. There is one type of live virus flu vaccine, the nasal vaccine, FluMist. But in this case, the virus is specially engineered to remove the parts of the virus that make people sick.

Flu Myth #5: There is no treatment for the flu. If you can get to the doctor quickly -- within 48 hours of having flu symptoms-- there are antiviral medications that can help. These drugs, such as Tamiflu and Relenza, won’t cure the flu. But they can reduce the amount of time you’re sick by one or two days and make you less contagious to others. These drugs work with both the typical strains of seasonal flu as well as swine flu.

Flu Myth #6: Antibiotics can fight the flu. Antibiotics only fight bacterial infections. Flu – whether it’s seasonal flu or swine flu -- is not caused by bacteria, but by a virus. So antibiotics have absolutely no effect on any kind of flu. But this message just won’t sink in for some people. “We still have oodles of patients coming into the doctors, or bringing their children to the doctors, who want antibiotics for influenza,” says Schaffner.

Flu Myth #7: The flu is only dangerous for the elderly. It’s true that the people most likely to become seriously ill or die from the seasonal flu are over age 65. But flu can become risky for anyone, even healthy young adults. Some of the most susceptible people to seasonal influenza are young children. Experts don’t have enough evidence yet to say whether young children are at increased risk from swine flu. However, based on past experience with the seasonal flu and previous flu pandemics, it’s possible. “Children under 2 years have some of the highest rates of hospitalization from [seasonal] flu,” says Hay. Children under 6 months are at the most risk from the seasonal flu because they’re too young to get the vaccine.

Flu Myth #8: “Stomach flu” is a form of influenza. The word “flu” is so overused that it’s lost much of its actual meaning. Gastrointestinal viruses are called the “stomach flu,” but they have no connection to the actual influenza virus. If you suffer vomiting and diarrhea, but no fever or body ache, you probably do not have the flu.

Flu Myth #9: If you get the flu, you can’t get it again during that flu season. Many people assume that if they’ve had the flu recently, they can’t get it again -- and thus don’t need to get the vaccine, Perl says. That’s not the case because the flu isn’t a single virus. “In any flu season, there’s usually both Type A and Type B influenza in circulation,” Perl tells WebMD. Both can cause the flu. It’s quite possible that you could get infected with one type and then the other.

Flu Myth #10: If you’re young and healthy, you don’t need to worry about getting the vaccine. First of all, we should all get the seasonal flu vaccine. Sure, if you’re in good health, you’ll probably recover from the seasonal flu just fine. But why suffer through the flu if you can avoid it? Second, protecting yourself isn’t the only reason to get vaccinated. “Healthy adults forget that while they themselves might be at low risk for getting serious flu complications, other people in their family might not,” says Hay. If you have a small child at home, or an older parent, your failure to get yourself vaccinated could endanger them. And that’s true on a larger, societal level. People with the weakest defenses, like children under 6 months, can’t get the flu vaccine. Their safety depends on the rest of us getting immunized.

Flu Myth #11: You can skip years between flu vaccinations. Experts say that some of us don’t understand that we need a new seasonal flu vaccine every year. “It’s confusing, since the flu vaccine is different from most vaccines, which offer longer-lasting protection,” says Schaffner. “With the measles vaccine, you get two injections and then you don’t have to worry about it for the rest of your life.” The flu vaccine isn’t like that.

Flu Myth #12: Vaccines are dangerous. In recent years, there’s been growing mistrust of vaccines, including the flu vaccine. Some believe that there could be a link between vaccines -- specifically the ingredient thimerosal -- and developmental disorders in children, like autism. However, there is no evidence that vaccines cause autism, and experts say that we’re losing sight of how important vaccines are. “Vaccines are, arguably, the greatest medical advance in history,” says Perl. They’ve prevented more illness and death than any treatment.

Flu Myth #13: Cold weather causes the flu. No matter what your grandmother may have said, going outside in the winter hatless does not increase your risk of flu. While there might seem to be a connection -- since flu season coincides with colder months in the U.S. -- there isn’t. After all, flu season is the same throughout the whole country: even if it’s frigid in Minnesota, it’s still warm in Florida. The rise and fall of flu season each year has more to do with the natural cycle of the virus, although experts aren’t exactly sure how it works.

Flu Myth #14: If you haven’t gotten the seasonal flu vaccine by November, there’s no point getting vaccinated. While supplies of vaccine used to run out by November, that’s not the case anymore, says Allen. Nowadays, there should be enough vaccine for anyone who wants it, and you should be able to get it as late as December or January. Besides, the flu often doesn’t hit its peak until February or sometimes as late as March.

(Original source article: http://www.webmd.com/cold-and-flu/features/top-14-flu-myths)

"A 98.8% passing rate...?"

While promoting and publishing my own CEN review course and CEN Review Manual, I have been keeping abreast of what others are doing out there.

One "competitior" company is Med-Ed. On their website they boldy proclaim a "98.8%" passing rate.
While they do not specific which exam that refers to, they do print it on their flyer for their CEN classes.

I found this passing rate pretty high and had some questions as to how they calculated it so on 9/12 I called them. I called their office in Charlotte and spoke with the lady who answered the phone. She was nice and pleasant. I introduced myself and stated that I was wondering about their quoted passing rate. I asked her how they knew who did and did not pass the exam. (I do not have her permission to use her name publicly, so I will honor that).

She politely told me that they know the pass rate based on the number of people who have requested a refund based on not passing their exam.

Okay, I can buy that, I guess. But, what if someone doesn't even take the exam? I asked her this, and she said, "well, why wouldn't they take it?".

So I clarified by saying to her that she was telling me that they calculate their pass rate based on how many attendees request a refund for not passing; she said "Yes"....

Seems to me this isn't very scientific at all.
Just because someone doesn't pass the exam, does NOT mean they will contact Med-Ed for a refund.

I can think of several scenarios where someone would NOT be contacting them for a refund....

1) If the attendee is taking the class merely for CEU (continuing education) purposes and they are already certified as a CEN - they have NO NEED to take the exam! (I've had a few of these people in my own classes)

2) If the attendee does not take their exam within the 60 day window, then they do not qualify for a refund; there is the potential for many delays in this 60 day time frame. It takes at LEAST 3-4 weeks to get the "permission to test" letter from the BCEN, then you still have to make an appointment to take the exam. Some exam centers have very limited openings.

3) Another person who would not qualify for a refund is an attendee who has had their registration paid for by the hosting institution in a "flat fee" pricing structure.

There are other permutations of similar scenarios here but I believe the point is clear, there is ABSOLUTELY no sure way to know who has not passed their CEN exam.

The opposite is true however, you can find out who HAS passed their exam by checking the BCEN website and looking at the names of those who have passed their CEN. However, that still would not account for those who have NOT taken it yet.

I'll be doing my own research and study from an upcoming Med-Ed CEN review class and seeing just who is and who isn't passing their exam and running my own numbers.

In the meantime, feel free to check out MY CEN revivew book which is 10% off through the end of September!

10% OFF Thru September 30, 2009

Use code "LULUBOOK" at checkout.

(Click on the Book to Preview or Purchase!)