Friday, October 20, 2006
Preparing for a pandemic
If an epidemic or pandemic (resistant flu) were to hit Carlisle, would we be prepared? In 1917, the Spanish Flu swept across the world, killing as many as 100 million people. Forty-five thousand died in Massachusetts. Can we even prepare for such an event?
"Public health was for a long time the forgotten child of emergency planning," says Board of Health (BOH) Agent Linda Fantasia. But starting with the 2001 anthrax scare, there was recognition "we need to increase the presence of public health in emergency response." As a result, national, state, and regional organizations have banded together to help supply information and resources.
Region 4A provides training, resources
The federal Bureau of Communicable Disease Control (CDC) requires each state to set up regional public health organizations to plan and prepare for a health emergency. In Massachusetts, five regions are organized under the Department of Public Health (DPH). Carlisle is in Region 4A, a consortium of 34 towns. The region purchases resources, such as decontamination units, for use by all towns. It also provides required training on the Incident Command System, which organizes local response, and the National Incident Management System for coordinating state and federal response.
Town representatives to Region 4A meet once per month to network, share ideas, and plan new initiatives. The region produces written materials, including the emergency information mailed to all Carlisle homes last month, and the Health Alert Network which informs each town of local outbreaks such as a recent West Nile case in Billerica. Region 4A is currently organizing mutual aid for towns needing more staff to deal with an emergency. For specialized services the region relies on DPH and Department of Public Service teams.
Local plan beefing up
Carlisle's Comprehensive Emergency Plan envisions a scenario where 80% of the population must be vaccinated within two days, as might be the case in a smallpox or flu epidemic. Medical Reserve Corps (MRC) volunteers are ready to step in (see Carlisle creates local Medical Reserve Corps, page 1) and the Carlisle School is designated as the dispensing location. Vaccines would be provided from the national stockpile.
However, flu vaccines can take some time to develop and may not be available fast enough to prevent an epidemic, according to Dr. Joseph Bergen, Chief of Emergency Services at Emerson Hospital, who was part of a presenting team at the Concord Carlisle Regional School Committee meeting on September 26. Dr. Glen Smith, Vice-president of Clinical Services and Dr. Deborah Greene, Emergency Medicine at Emerson Hospital also spoke about the unique challenges that may be facing the community in the case of an epidemic.
Hospitals could be overwhelmed
According to Bergen, "Preparation must be local. Hospitals will be overwhelmed. They are already working close to capacity." An article in the Boston Globe ("Bay State Not Ready for a Flu Epidemic" October 3), confirmed his opinion, "On the best days Massachusetts hospitals have barely enough beds and ventilators to handle the regular patient load, and they would be staggered by an onslaught of wheezing, feverish flu patients in an epidemic."
The CDC estimates that 0.3% of the population could die from a pandemic flu, and 0.5% percentage may need long-term care. The Emerson Hospital region has about 105,000 people, so 200 to 500 beds could be needed; Emerson currently has 95. In addition, back up emergency workers will be required as 40% of hospital staff could be stricken.
Overflow sites needed
Dr. Greene spoke about special care units to be opened "when the hospital is full to the brim." Greene expects up to 200 people may have to be accommodated in the special care units with one nurse for every 10 to 20 patients, rather than the usual four to six patients. According to Smith, a large area is needed with a kitchen, water, showers, toilets, parking for staff, emergency power and a wireless network. Concord schools are being considered, especially Sandborn, since it is near the hospital, but Concord Carlisle High School would not be used because it is already designated as a shelter.
Fantasia notes Carlisle's local schools and churches are designated "level 3" shelters in an epidemic if all other resources have been exhausted. The town would rely on the state stockpile of cots and respirators. However the Globe article cited above says a bill to purchase emergency supplies has been held up in the legislature, leaving the state unprepared to supply hospitals and overflow sites this year.
Emergency preparedness has "been a huge undertaking for the Board of Health," says Fantasia. "The learning curve has been tremendous." But she believes the focus on preparedness for a public health emergency has been "very valuable," particularly the networking with the hospital and other health agents. If an emergency arose, not only is it clear who to contact, but the personal ties have already been formed. As one experienced emergency health worker told Fantasia, "the worst time to meet for the first time is at a disaster site.
Preparing in the home
Every official involved with Carlisle's emergency planning has worked overtime to prepare for a range of scenarios and to coordinate plans on a regional, state, and national level. But in the end, each admits the most important level of emergency preparedness is in the home. "Everyone should have a survival kit," says Linda Fantasia. "In an emergency, it could be two or three days before the state arrives." And given the level of state preparedness cited by the Boston Globe, you may want to be ready to provide your own bandages, medicines, and cots.
The fire department section of the town website (www.carlislema.gov) lists several emergency organizations with suggestions for preparedness. Other ideas are contained in a flyer entitled "Family Disaster Plan" sent to each Carlisle home in September. Additional copies are available at Town Hall.
© 2006 The