User Panel
User Panel
User Panel
|
Posted: 10/4/2014 5:09:11 AM EDT
[#1]
Quote HistoryQuoted:
It is a valid question, but I do not think it matters. Here is why. This is all predicated on there not being a real time flu test. I do not know if there is or not. Maybe somebody can answer that. If there is, I am going to buy their stock ASAP. If we get secondary and tertiary cases and If the case infection rate is that of West Africa, it will take several months to become endemic in multiple cities. At that point in time we will be smack dab in the middle of flu season. 2 things will happen. People with ebola will assume they have the flu and not go to doctors or hospitals and will infect many more people and People with flu will go to hospitals thinking they may have ebola. The hospitals will not have the space to isolate everyone with symptoms and people with ebola will not get isolated until well into the disease. This will likely overwhelm the ERs and the test results will take much longer due to back log. At this point the healthcare system could collapse trying to treat and test everyone that presents with flu /ebola symptoms. TLDR. It isn't how many actual ebola patients hospitals can handle, it will be the shear number of people that have the same initial symptoms due to flu that will overwhelm healthcare, because hospitals will not be able to tell the difference quickly enough. Unless there is a rapid real time flu test. Is there? ETA: Fixed most of it I think. I don't have a proper keyboard, just an iPotato.  CDC article on rapid Flu diagnostic tests and the companies that make them. Lot of gibberish to me, but here you go. |
|
|
|
Posted: 10/4/2014 5:47:40 AM EDT
[#2]
For those in the know, when does an infected individual become contagious? How long does the virus survive without a host? Is it minutes like with HIV or days to weeks like with Hepatitis? The shorter the time from manifestation of symptoms in an infected individual to the individual becoming a contagion will make all the difference in how fast or how much it will spread.
The reply about utilization of hospital resources was interesting, however I do not think that would be the case in my system. On our average days we are on constant transfer secondary to every bed in our hospital being occupied, those who refuse transfer sit in beds in the hallways. Even our sister hospitals we transfer to are full or near full on a regular basis. It's not a question of staff, it's a matter of space. Unless we were to double or triple up patients in rooms constructed for single patient use, any level of mass casualty or any kind of infection scare would cripple us. The other hospitals in town are just about on par with daily patient load. There is also a stunning lack of training on how to handle such an event. We have never done drills, we have no event plans, the most we have ever covered are mass triages and hazmat exposures. |
|
|
|
Posted: 10/4/2014 6:04:28 AM EDT
[#3]
Quote HistoryQuoted:
For those in the know, when does an infected individual become contagious? How long does the virus survive without a host? Is it minutes like with HIV or days to weeks like with Hepatitis? The shorter the time from manifestation of symptoms in an infected individual to the individual becoming a contagion will make all the difference in how fast or how much it will spread. The reply about utilization of hospital resources was interesting, however I do not think that would be the case in my system. On our average days we are on constant transfer secondary to every bed in our hospital being occupied, those who refuse transfer sit in beds in the hallways. Even our sister hospitals we transfer to are full or near full on a regular basis. It's not a question of staff, it's a matter of space. Unless we were to double or triple up patients in rooms constructed for single patient use, any level of mass casualty or any kind of infection scare would cripple us. The other hospitals in town are just about on par with daily patient load. There is also a stunning lack of training on how to handle such an event. We have never done drills, we have no event plans, the most we have ever covered are mass triages and hazmat exposures. Answered my own question, for the most part anyway. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php SURVIVAL OUTSIDE HOST: Filoviruses have been reported capable to survive for weeks in blood and can also survive on contaminated surfaces, particularly at low temperatures (4°C) Footnote 52 Footnote 61. One study could not recover any Ebolavirus from experimentally contaminated surfaces (plastic, metal or glass) at room temperature Footnote 61. In another study, Ebolavirus dried onto glass, polymeric silicone rubber, or painted aluminum alloy is able to survive in the dark for several hours under ambient conditions (between 20 and 250C and 30–40% relative humidity) (amount of virus reduced to 37% after 15.4 hours), but is less stable than some other viral hemorrhagic fevers (Lassa) Footnote 53. When dried in tissue culture media onto glass and stored at 4 °C, Zaire ebolavirus survived for over 50 days Footnote 61. This information is based on experimental findings only and not based on observations in nature. This information is intended to be used to support local risk assessments in a laboratory setting. A study on transmission of ebolavirus from fomites in an isolation ward concludes that the risk of transmission is low when recommended infection control guidelines for viral hemorrhagic fevers are followed Footnote 64. Infection control protocols included decontamination of floors with 0.5% bleach daily and decontamination of visibly contaminated surfaces with 0.05% bleach as necessary. |
|
|
|
Posted: 10/4/2014 6:11:35 AM EDT
[#4]
Quote HistoryQuoted:
The revenue cycle would work as well as the documentation allowed. At the beginning you would still have sufficient time to gather the required documentation to bill individual insurances. However as the outbreak ramped up documentation would decline and payment for services would suffer. You'd have the majority of the burden initially absorbed by the individual facilities. Then as things cooled down you'd probably see lump reimbursement from the state and federal disaster relief funds. It would definately be a CFO's worst nightmare. Quote HistoryQuoted:
Quoted:
I wonder who would pay for the hospitals' costs? Hospitals, in fact anything medical related, as you know is incredibly expensive. Throw an ebola outbreak into the mix and the costs increase geometrically. The revenue cycle would work as well as the documentation allowed. At the beginning you would still have sufficient time to gather the required documentation to bill individual insurances. However as the outbreak ramped up documentation would decline and payment for services would suffer. You'd have the majority of the burden initially absorbed by the individual facilities. Then as things cooled down you'd probably see lump reimbursement from the state and federal disaster relief funds. It would definately be a CFO's worst nightmare. If it got that bad, the delivery of goods would suffer greatly, so at some point it would be chaos not just from ebola and billing but from hungry people too. |
|
|
|
Posted: 10/4/2014 6:13:12 AM EDT
[#5]
Quote HistoryQuoted:
A survey of nurses around the US found that most had no idea what their hospital's plan was, that most believed they had inadaquate amounts of protective gear, and that most hospitals lack or had few overpressure rooms within their facilities. This may get ugly. I think the average is two....And those are usually occupied. |
|
|
|
Posted: 10/4/2014 6:16:25 AM EDT
[#6]
How many isolation rooms ya got?
|
|
|
|
Posted: 10/4/2014 6:18:13 AM EDT
[#7]
Quote HistoryQuoted:
So Ebola was already in the US in 1989? Interesting. Quote HistoryQuoted:
Quoted:
the senior scientist at USAMRIID who was called to the office at four in the morning on October 16th, 2001, when the Daschle letter full of anthrax was being analyzed at the Institute, is the co-discoverer and namer of the Ebola Reston virus, the only type of Ebola that has ever been seen in the Western Hemisphere. There are now five identified species of Ebola. The hottest of them, Ebola Zaire, kills up to ninety-five percent of its infected victims, and there is no cure for it. Jahrling discovered the Ebola Reston virus in 1989, during an outbreak of Ebola in Reston, Virginia, a suburb of Washington, D.C. Before he knew what the virus was, he inadvertently inhaled a whiff of it from a small flask. Tom Geisbert, the USAMRIID microscopist whom Jahrling would later ask to examine the Daschle anthax, also took a whiff. The two scientists tested their blood every day for a while after that, but they never became sick. They are the official codiscoverers of Ebola Reston, and they have continued to collaborate on research into Ebola. Peter Jahrling also discovered that an antiviral drug called ribaviran can be used successfully to cure people who are infected with Lassa, the Level 4 virus that turns people into bleeders. In the nineteen nineties, as the presence of biological weapons in Russia and other countries became more obvious and more alarming, Peter Jahrling expanded his interests beyond Ebola and began to study smallpox. So Ebola was already in the US in 1989? Interesting. Monkeys. |
|
|
|
Posted: 10/4/2014 6:19:24 AM EDT
[#8]
Quote HistoryQuoted:
CDC article on rapid Flu diagnostic tests and the companies that make them. Lot of gibberish to me, but here you go. Quote HistoryQuoted:
Quoted:
It is a valid question, but I do not think it matters. Here is why. This is all predicated on there not being a real time flu test. I do not know if there is or not. Maybe somebody can answer that. If there is, I am going to buy their stock ASAP. If we get secondary and tertiary cases and If the case infection rate is that of West Africa, it will take several months to become endemic in multiple cities. At that point in time we will be smack dab in the middle of flu season. 2 things will happen. People with ebola will assume they have the flu and not go to doctors or hospitals and will infect many more people and People with flu will go to hospitals thinking they may have ebola. The hospitals will not have the space to isolate everyone with symptoms and people with ebola will not get isolated until well into the disease. This will likely overwhelm the ERs and the test results will take much longer due to back log. At this point the healthcare system could collapse trying to treat and test everyone that presents with flu /ebola symptoms. TLDR. It isn't how many actual ebola patients hospitals can handle, it will be the shear number of people that have the same initial symptoms due to flu that will overwhelm healthcare, because hospitals will not be able to tell the difference quickly enough. Unless there is a rapid real time flu test. Is there? ETA: Fixed most of it I think. I don't have a proper keyboard, just an iPotato. CDC article on rapid Flu diagnostic tests and the companies that make them. Lot of gibberish to me, but here you go. Thanks. Reading that tells me it might help, but due to a high false negative rate, they recommend a PCR test if clinical decisions must be made due to test results. Doesn't sound too promising, But I don't know enough. |
|
|
|
Posted: 10/4/2014 6:43:25 AM EDT
[#9]
Quote HistoryQuoted:
How many isolation rooms ya got? Most newer hospitals have single patient rooms so in essence every room in these is an isolation room. However most older hospitals have multiple patient rooms, so the question should be how many single patient rooms do(es) your local hospital(s) have? |
|
|
|
Posted: 10/4/2014 7:07:48 AM EDT
[#10]
Quote HistoryQuoted: No idea. But I do know that I've heard reports of 90+ rooms being dedicated for ebola outbreak in my AO by the big two local to me hospitals. Posted Via AR15.Com Mobile |
|
|
|
Posted: 10/4/2014 7:48:56 AM EDT
[#11]
Between 2 and 10, depending on the zeros in their budget.
|
|
|
|
Posted: 10/4/2014 9:19:10 AM EDT
[#12]
Quote HistoryQuoted:
The hospital I worked at would be pretty well screwed. Hazmat is shipped out for incineration. Off the top of my head, there are 3 isolation pods and a decon suite in the ED and whatever they can neg pressure in the ICU. About it. I wonder if the usual decon stuff works on ebola. I figure if stuff will kill cdif and then you hit the room with virex II afterwards, I'd hope it was toast. Then again bsl-4 viruses are a bastard. Realistically, 3-5 patients at most and they'd be fucked. Some days, I miss my old job until I remember all the crap I was exposed to. Hell, PPD other than gloves/masks/face shields was in a secure room that I'd need security to unlock. Only ever saw it once, and I doubt most employees even knew it was there. To be brutally honest, if it became a pandemic we're fucked. Thankfully, ebola isn't (currently) transmittable through the air so contact precautions are all that is needed. Would love to see the emails floating around the hospital about it though. (for the record, I was patient facing admin/clerical) Quote HistoryQuoted:
Quoted:
I bet that even just 1 would screw up most hospitals. Most housekeeping departments wouldn't know what to do with that level of hazmat even if they could find staff that would be willing to even go near the room where an infected patient has been. And heaven help the hospital that doesn't have their own incinerator onsite. The hospital I worked at would be pretty well screwed. Hazmat is shipped out for incineration. Off the top of my head, there are 3 isolation pods and a decon suite in the ED and whatever they can neg pressure in the ICU. About it. I wonder if the usual decon stuff works on ebola. I figure if stuff will kill cdif and then you hit the room with virex II afterwards, I'd hope it was toast. Then again bsl-4 viruses are a bastard. Realistically, 3-5 patients at most and they'd be fucked. Some days, I miss my old job until I remember all the crap I was exposed to. Hell, PPD other than gloves/masks/face shields was in a secure room that I'd need security to unlock. Only ever saw it once, and I doubt most employees even knew it was there. To be brutally honest, if it became a pandemic we're fucked. Thankfully, ebola isn't (currently) transmittable through the air so contact precautions are all that is needed. Would love to see the emails floating around the hospital about it though. (for the record, I was patient facing admin/clerical) My reason in asking the question is to point out that it wouldn't take much to turn us from a first world healthcare system to what we see in West Africa. So it is a very complex situation when a hospital gets a patient or series of patients like the one in Texas. Now consider if his family members or even one or two come down with the virus. Consider if the city sanitary system workers come down down with the virus.......Will it even matter how hard it is to catch it? Will the ambulance drivers show up to work? will the first responders? how about intake? housekeeping? |
|
|
|
Posted: 10/4/2014 9:23:48 AM EDT
[#13]
Quote HistoryQuoted:
Answered my own question, for the most part anyway. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php SURVIVAL OUTSIDE HOST: Filoviruses have been reported capable to survive for weeks in blood and can also survive on contaminated surfaces, particularly at low temperatures (4°C) Footnote 52 Footnote 61. One study could not recover any Ebolavirus from experimentally contaminated surfaces (plastic, metal or glass) at room temperature Footnote 61. In another study, Ebolavirus dried onto glass, polymeric silicone rubber, or painted aluminum alloy is able to survive in the dark for several hours under ambient conditions (between 20 and 250C and 30–40% relative humidity) (amount of virus reduced to 37% after 15.4 hours), but is less stable than some other viral hemorrhagic fevers (Lassa) Footnote 53. When dried in tissue culture media onto glass and stored at 4 °C, Zaire ebolavirus survived for over 50 days Footnote 61. This information is based on experimental findings only and not based on observations in nature. This information is intended to be used to support local risk assessments in a laboratory setting. A study on transmission of ebolavirus from fomites in an isolation ward concludes that the risk of transmission is low when recommended infection control guidelines for viral hemorrhagic fevers are followed Footnote 64. Infection control protocols included decontamination of floors with 0.5% bleach daily and decontamination of visibly contaminated surfaces with 0.05% bleach as necessary. Quote HistoryQuoted:
Quoted:
For those in the know, when does an infected individual become contagious? How long does the virus survive without a host? Is it minutes like with HIV or days to weeks like with Hepatitis? The shorter the time from manifestation of symptoms in an infected individual to the individual becoming a contagion will make all the difference in how fast or how much it will spread. The reply about utilization of hospital resources was interesting, however I do not think that would be the case in my system. On our average days we are on constant transfer secondary to every bed in our hospital being occupied, those who refuse transfer sit in beds in the hallways. Even our sister hospitals we transfer to are full or near full on a regular basis. It's not a question of staff, it's a matter of space. Unless we were to double or triple up patients in rooms constructed for single patient use, any level of mass casualty or any kind of infection scare would cripple us. The other hospitals in town are just about on par with daily patient load. There is also a stunning lack of training on how to handle such an event. We have never done drills, we have no event plans, the most we have ever covered are mass triages and hazmat exposures. Answered my own question, for the most part anyway. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php SURVIVAL OUTSIDE HOST: Filoviruses have been reported capable to survive for weeks in blood and can also survive on contaminated surfaces, particularly at low temperatures (4°C) Footnote 52 Footnote 61. One study could not recover any Ebolavirus from experimentally contaminated surfaces (plastic, metal or glass) at room temperature Footnote 61. In another study, Ebolavirus dried onto glass, polymeric silicone rubber, or painted aluminum alloy is able to survive in the dark for several hours under ambient conditions (between 20 and 250C and 30–40% relative humidity) (amount of virus reduced to 37% after 15.4 hours), but is less stable than some other viral hemorrhagic fevers (Lassa) Footnote 53. When dried in tissue culture media onto glass and stored at 4 °C, Zaire ebolavirus survived for over 50 days Footnote 61. This information is based on experimental findings only and not based on observations in nature. This information is intended to be used to support local risk assessments in a laboratory setting. A study on transmission of ebolavirus from fomites in an isolation ward concludes that the risk of transmission is low when recommended infection control guidelines for viral hemorrhagic fevers are followed Footnote 64. Infection control protocols included decontamination of floors with 0.5% bleach daily and decontamination of visibly contaminated surfaces with 0.05% bleach as necessary. I'm a layperson, I do not work in the healthcare system, and anyone here can tell that, but, what happens when staff starts to stop showing up? when housekeeping starts to get sick? even if it is from the flue? Something tells me that the CDC, the Administration, those in the know are way more concerned then they let on. |
|
|
|
Posted: 10/4/2014 9:25:55 AM EDT
[#14]
Quote HistoryQuoted:
I think the average is two....And those are usually occupied. Quote HistoryQuoted:
Quoted:
A survey of nurses around the US found that most had no idea what their hospital's plan was, that most believed they had inadaquate amounts of protective gear, and that most hospitals lack or had few overpressure rooms within their facilities. This may get ugly. |
|
|
|
Posted: 10/4/2014 9:30:18 AM EDT
[#15]
Quote HistoryQuoted:
The hospital where I work in Dallas has two each on both 3rd & 4th floors for a total of 4. Quote HistoryQuoted:
Quoted:
Quoted:
A survey of nurses around the US found that most had no idea what their hospital's plan was, that most believed they had inadaquate amounts of protective gear, and that most hospitals lack or had few overpressure rooms within their facilities. This may get ugly. We have a few. My 500 bed hospital can handle 20, if we strip 2 full floors of nursing. |
|
|
|
Posted: 10/4/2014 9:33:51 AM EDT
[#16]
Quote HistoryQuoted:
We have a few. My 500 bed hospital can handle 20, if we strip 2 full floors of nursing. Quote HistoryQuoted:
Quoted:
Quoted:
Quoted:
A survey of nurses around the US found that most had no idea what their hospital's plan was, that most believed they had inadaquate amounts of protective gear, and that most hospitals lack or had few overpressure rooms within their facilities. This may get ugly. We have a few. My 500 bed hospital can handle 20, if we strip 2 full floors of nursing. How will Zerocare affect the whole mess? |
|
|
|
Posted: 10/4/2014 9:38:33 AM EDT
[#17]
Quote HistoryQuoted:
I'm a layperson, I do not work in the healthcare system, and anyone here can tell that, but, what happens when staff starts to stop showing up? when housekeeping starts to get sick? even if it is from the flu? If there is such a scenario that there is no staff to put hands on the patients, then the patients are basically just warehoused/isolated until they expire or get over it on their own. 
I'm prn and work another full-time job in an medical insurance related company. I don't need the $$$ from nursing(but it does pay for some nice man toyz  ), but I don't need the money that bad to be exposed to Ebola.
Unless they're offering some serious( and I mean serious ) bonuses for that risk/reward ratio. |
|
|
|
Posted: 10/4/2014 9:44:37 AM EDT
[#18]
Quote HistoryQuoted:
Well, we currently have a bunch of nosocomial C Diff so obviously contact precautions are not being followed. It stems from understaffing. You know how 90% of arfcom is completely retarded about Ebola? Well, about 50% of nurses would be the same way. We'd have more understaffing, limiting our ability to care for Ebola patients. In an ideal world, you can put an Ebola patient in a room and slap an contact isolation sign outside. In the real world, it doesn't work like that. Quote HistoryQuoted:
Quoted:
Quoted:
I've worked in hospitals for the last 20ish years. There is no "average" hospital. I work in a 24-bed ICU. I'd estimate we could handle about 6 Ebola cases. It's just a "this is what I think" number and I have no data or reasoning I can share to back it up. If it really is not airborne, then you could probably fill each bed with an Ebola patient, but you would have to be conservative in your nurse to patient ratio. Contact precautions would have to be followed to a T. Well, we currently have a bunch of nosocomial C Diff so obviously contact precautions are not being followed. It stems from understaffing. You know how 90% of arfcom is completely retarded about Ebola? Well, about 50% of nurses would be the same way. We'd have more understaffing, limiting our ability to care for Ebola patients. In an ideal world, you can put an Ebola patient in a room and slap an contact isolation sign outside. In the real world, it doesn't work like that. I definitely meant only ICU beds because of the intensive care each patient would need. But, yeah, even in the ICU some nurses are terrible about contact precautions. In theory, it could be handled in the ICU if: 1) There is a 1:1 or 1:2 nurse to patient ratio. <---------Wouldn't happen because the hospital is too cheap. 2) Absolutely no visitors. 3) Nurses, LNA's, doctors, cleaning staff would have to follow strict contact precautions which they probably would not. One big problem would be people refusing to work. Every vacation/sick day would be cashed in or people would quit. No fucking way would I see Ebola patients in consultation. I hate going into the ICU as it is, I'm not dying over it. |
|
|
|
Posted: 10/4/2014 9:50:26 AM EDT
[#19]
Quote HistoryQuoted:
An additional concern would be how many healthcare and support workers would be AWOL. I'm a FF/PM and there is a point that I would stop going to work and get my family to our remote bug out location. Exactly. No fucking way would I trust the hospital or government to protect me. You would be cannon fodder, like the Chernobyl firefighters. |
|
|
|
Posted: 10/4/2014 9:51:23 AM EDT
[#20]
Quote HistoryQuoted:
The main problem is that they can't handle the amount of toxic waste the patients generate: Link Rules would have to be changed with some other methods used to incinerate the infected waste. |
|
|
|
Posted: 10/4/2014 9:52:23 AM EDT
[#21]
Quote HistoryQuoted:
How will Zerocare affect the whole mess? Quote HistoryQuoted:
Quoted:
Quoted:
Quoted:
Quoted:
A survey of nurses around the US found that most had no idea what their hospital's plan was, that most believed they had inadaquate amounts of protective gear, and that most hospitals lack or had few overpressure rooms within their facilities. This may get ugly. We have a few. My 500 bed hospital can handle 20, if we strip 2 full floors of nursing. How will Zerocare affect the whole mess? No idea on that side of the house, I'd imagine you'd have to see how quickly people died vs successful treatment and repayment for both. Since we lose money on every medicare/medicaid patient I'd say we'd just chalk it up to more loses. Cuomo fucked nurses over in their contracts so good luck getting RNs to come in to work in Level 4 bio-containment. US CDC is treating Ebola as a droplet precaution at this time as per my hospital. |
|
|
|
Posted: 10/4/2014 10:09:25 AM EDT
[#22]
What a wonderful coincidence that Obamacare took effect the same time we are looking at a terrible pandemic!
The government will save us all! The health care system is going to be a really screwed up mess if this pandemic plays out. 
|
|
|
|
Posted: 10/4/2014 10:11:21 AM EDT
[#23]
Quote HistoryQuoted:
2... Yep. Most hospitals are not set up for such a thing. Posted Via AR15.Com Mobile |
|
|
|
Posted: 10/4/2014 10:11:51 AM EDT
[#24]
Thanks. Reading that tells me it might help, but due to a high false negative rate, they recommend a PCR test if clinical decisions must be made due to test results. Doesn't sound too promising, But I don't know enough. Pretty much the POC tests are used for initial screening, but in my experience the PCR test is used as the definitive test for patient management for Flu patients. Same with the POC strep tests. If the POC strep is negative, we still sent a routine culture. |
|
|
|
Posted: 10/4/2014 10:14:31 AM EDT
[#25]
I watched an interview with a guy from the company that made the drugs that saved the couple of guys they tested it on. He said they're out and there's more in the pipeline but that batch won't be ready for another month.
|
|
|
|
Posted: 10/4/2014 10:21:26 AM EDT
[#26]
Quote History[b]Quoted:.
Short answer to the original question. Our healthcare system can handle a LOT. But that means we are in a bad place, and almost any resemblance of what our hospitals look like today would be gone. Generally a hospital is certified to care for a certain number of patients. But every hospital backs off that number when staffing for day to day activities, generally about 50%. And actual utilization of facility services generally hover around 50% of what day to day staffing can handle. So, if we are in a shit hit the fan scenerio and we are calling out all the stops...all physicians are on duty, all nurses, all techs, etc. A hospital can generally handle between 3-400% more capacity than they would on a normal 'busy' day. This would not be a pretty scenerio. Care given would be the primary concern. You wouldn't see full documentation, charts, etc...billing would be suspended, it would be a completely new world. Sorry I have to disagree. In the Northeast most hospitals run at 100% capacity during the flu season. This year hit early. To say hospitals could increase their capacity 50% is simply not reality based. The Er I currently work in runs 100% + capacity most days now. To try and increase that number would require practice changes that practitioners and patients wouldn`t accept. In northern NJ, If you told patients they would have to go in a hallway, or an open ward ( if any still exist), they would have a sh*t fit. And you would have the patient satisfaction clowns compromising patient and staff safety for the sake of their Press-Ganey scores. |
|
|
|
Posted: 10/4/2014 10:22:07 AM EDT
[#27]
Infinite amount, if they send them home with antibiotics.
|
|
|
|
Posted: 10/4/2014 10:43:45 AM EDT
[#28]
I'd guess 4. once you get past that the logistics become difficult. Past 6 at a mid size hospital or 10 at a large one things start to fall apart. There simply are not enough competent trained people at that point. And that isn't taking into account those who will not show up to work when their are 10 bola patients waiting for them.
|
|
|
|
Posted: 10/4/2014 11:07:31 AM EDT
[#29]
Quote HistoryQuoted:
Dyezak: So, if we are in a shit hit the fan scenerio and we are calling out all the stops...all physicians are on duty, all nurses, all techs, etc. A hospital can generally handle between 3-400% more capacity than they would on a normal 'busy' day. This would not be a pretty scenerio. Care given would be the primary concern. You wouldn't see full documentation, charts, etc...billing would be suspended, it would be a completely new world. So the real question is...how long could we keep that level of care going? A month? Six weeks? I wouldn't bet on anything longer than 2 months at most. And could we squash your hypothetical outbreak in that amount of time..." At that level of hospital 'utilization' most people will avoid hospitals 'like the plague'... There will be in short order millions of infected, going without care, dying at home, in the streets, or in makeshift quarantine sites. It will get ugly. Middle ages, medieval ugly. Except with rifles. +1 No way I would go to work. That's SHTF. Ain't nobody got time for Ebola! At that point, all transportation shuts down. Martial law with strict curfew. Wait until the epidemic burns itself out. Posted Via AR15.Com Mobile |
|
|
|
Posted: 10/4/2014 11:08:29 AM EDT
[#30]
Quote HistoryQuoted:
everybody who is needed will show up. I have zero doubts in that regard Quote HistoryQuoted:
Quoted:
probably depends a little on how many people are still going to work at the hospital if it gets that bad everybody who is needed will show up. I have zero doubts in that regard You know very little about human nature.  Posted Via AR15.Com Mobile |
|
|
|
Posted: 10/4/2014 11:46:51 AM EDT
[#31]
Quote HistoryQuoted:
You know very little about human nature.
Posted Via AR15.Com Mobile Quote HistoryQuoted:
Quoted:
Quoted:
probably depends a little on how many people are still going to work at the hospital if it gets that bad everybody who is needed will show up. I have zero doubts in that regard You know very little about human nature.
Posted Via AR15.Com Mobile Perhaps he was being sarcastic? |
|
|
|
Posted: 10/4/2014 2:49:55 PM EDT
[#32]
Only answer is what I heard on the radio yesterday. Set up fever centers for the Ebola outbreak. Of course if you get the flu you will end up with the Ebola victims.
Any other answer is incorrect. As soon as your hospital has Ebola people will stop coming. Both patients and employees.
|
|
|
|
Posted: 10/4/2014 3:19:51 PM EDT
[#33]
Quote HistoryQuoted:
You know very little about human nature.
Posted Via AR15.Com Mobile Quote HistoryQuoted:
Quoted:
Quoted:
probably depends a little on how many people are still going to work at the hospital if it gets that bad everybody who is needed will show up. I have zero doubts in that regard You know very little about human nature.
Posted Via AR15.Com Mobile Quite a while ago, a Level II facility on the Space Coast was in the projected path of a hurricane. A huge portion of the workforce didn't show up during a declared emergency (county ordered evacuation). The projected path turned out to be a bit wrong. Many of them were laid off/ fired in a relatively small time frame after a return to normal operations. It's a sizeable hospital. |
|
|
|
Posted: 10/4/2014 4:37:33 PM EDT
[#34]
Quote HistoryQuote HistoryQuoted: Quoted: Quoted: Quoted: Quoted: I wonder who would pay for the hospitals' costs? Hospitals, in fact anything medical related, as you know is incredibly expensive. Throw an ebola outbreak into the mix and the costs increase geometrically. The revenue cycle would work as well as the documentation allowed. At the beginning you would still have sufficient time to gather the required documentation to bill individual insurances. However as the outbreak ramped up documentation would decline and payment for services would suffer. You'd have the majority of the burden initially absorbed by the individual facilities. Then as things cooled down you'd probably see lump reimbursement from the state and federal disaster relief funds. It would definately be a CFO's worst nightmare. Its actually all surprisingly well laid out for anyone who cares to look at it. The Finance section actually makes up one quarter of the 4 primary sections that form up under Unified Command/Incident Command response. Im to lazy to type it all out but they are surprisingly thorough. I am eagerly awaiting your next post where you point me to where I can look. I really wonder how long the hospitals can go before they get any sort of payment or reimbursement. Hospitals are already strapped for cash in many cases, I see it every day because I'm in medical service/sales and used to work at one. How long could they absorb the costs, especially costs for treating fucking ebola, before they have they implode? I'm curious about what pwr2al4 referenced as that would probably answer a lot of my questions. Check this out http://emilms.fema.gov/IS100hcb/index.htm yeah, well I didnt quite get that basic , but yeah your right, I probably should of prefaced my statements since we are both looking at this from opposite ends of the same street. I had like a 5 paragraph explanation all typed up, but perhaps I should save it for another time. All the inforamation that you are looking for I pulled out of a couple of old manuals sitting on a shelf in the basement that have been (thankfully) just collecting dust for a while now. The main one is my old Advanced Disaster Life Support manual which essentially sets the current standards on how any serious type of Mass Casualty Incident is going to be dealt with begining from the local, State and finally Federal level. It was developed or (redeveloped) I believe via a joint effort from the AMA, Homeland, the National Domestic Prepardness Consortium, and a handful of other agencies and organizations and then came down to me through DHS or Fema or one of those types of clusterfuck .gov organizations. As far as I know its all completely open source and should all be there via google. If not they do cite the entire manual with sources so I can get more specific if need be. |
|
|
|
Posted: 10/4/2014 4:43:43 PM EDT
[#35]
Biggest hospital in my area has 10 beds setup for potential Ebola patients.
|
|
|
|
Posted: 10/4/2014 4:44:26 PM EDT
[#36]
Doesn't anybody watch the walking dead?
|
|
|
|
Posted: 10/4/2014 4:45:48 PM EDT
[#37]
The US health care system will not be able to handle a significant outbreak of Ebola if/when it occurs in the US and we will be proper fucked.
The small community hospital in which I now work could likely not handle a single case. <---------------------------RN for 21 years (mostly in ER.) |
|
|
|
Posted: 10/4/2014 4:57:29 PM EDT
[#38]
Quote HistoryQuoted: My reason in asking the question is to point out that it wouldn't take much to turn us from a first world healthcare system to what we see in West Africa. So it is a very complex situation when a hospital gets a patient or series of patients like the one in Texas. Now consider if his family members or even one or two come down with the virus. Consider if the city sanitary system workers come down down with the virus.......Will it even matter how hard it is to catch it? Will the ambulance drivers show up to work? will the first responders? how about intake? housekeeping? Quote HistoryQuoted: Quoted: Quoted: I bet that even just 1 would screw up most hospitals. Most housekeeping departments wouldn't know what to do with that level of hazmat even if they could find staff that would be willing to even go near the room where an infected patient has been. And heaven help the hospital that doesn't have their own incinerator onsite. The hospital I worked at would be pretty well screwed. Hazmat is shipped out for incineration. Off the top of my head, there are 3 isolation pods and a decon suite in the ED and whatever they can neg pressure in the ICU. About it. I wonder if the usual decon stuff works on ebola. I figure if stuff will kill cdif and then you hit the room with virex II afterwards, I'd hope it was toast. Then again bsl-4 viruses are a bastard. Realistically, 3-5 patients at most and they'd be fucked. Some days, I miss my old job until I remember all the crap I was exposed to. Hell, PPD other than gloves/masks/face shields was in a secure room that I'd need security to unlock. Only ever saw it once, and I doubt most employees even knew it was there. To be brutally honest, if it became a pandemic we're fucked. Thankfully, ebola isn't (currently) transmittable through the air so contact precautions are all that is needed. Would love to see the emails floating around the hospital about it though. (for the record, I was patient facing admin/clerical) My reason in asking the question is to point out that it wouldn't take much to turn us from a first world healthcare system to what we see in West Africa. So it is a very complex situation when a hospital gets a patient or series of patients like the one in Texas. Now consider if his family members or even one or two come down with the virus. Consider if the city sanitary system workers come down down with the virus.......Will it even matter how hard it is to catch it? Will the ambulance drivers show up to work? will the first responders? how about intake? housekeeping? |
|
|
|
Posted: 10/4/2014 5:19:15 PM EDT
[#39]
Quoted:
How many Ebola patients would it take to overwhelm an American hospital? Every report is saying that we have the best system for handling it, but at what point would our system be degraded to the point where it is not effective, and swamped? How much emergency supplies do hospitals carry on their books? and how fast would they go through them in an all out epidemic of any sort? According to NBC news, Eric Duncan occupies one room on an empty floor with 60 beds at Dallas Presbyterian Hospital.
|
|
|
|
Posted: 10/4/2014 5:25:10 PM EDT
[#40]
If we include Veteran's Administration hospitals in the calculation of average, the answer is - 243.6.
|
|
|
|
Posted: 10/4/2014 5:29:06 PM EDT
[#41]
Quote HistoryQuoted: Thanks. Reading that tells me it might help, but due to a high false negative rate, they recommend a PCR test if clinical decisions must be made due to test results. Doesn't sound too promising, But I don't know enough. Pretty much the POC tests are used for initial screening, but in my experience the PCR test is used as the definitive test for patient management for Flu patients. Same with the POC strep tests. If the POC strep is negative, we still sent a routine culture. this is how its been for decades at this point. I used to get strep as a child a lot and I remember my father finally just brought home the Kodak brand RST. And running a PCR's isnt rocket science fwiw. I dont know if Ebola can be put through a Rapid PCR, I suspect it can but I'll best to stick with facts. So worst case your looking at a 24-36 hour turn around on definite results. Everybody needs to take a breath and calm down. The sky is not falling. Ebola is not the fire breathing monster sent by satan himself that spreads like wildfire and can wipes out whole cities in in a matter of days. There is a nightmare strain out there which does frankly scare the shit out of me and it goes by the name is variola major. This is not that, not even close. were talking about ppe and droplet precautions here. Although I would never argue against being prudent in situations like this. For anyone who recieved the HAN fom the CDC on Thursday evening, to me it couldnt have sounded less alarming if they tried. Let the public freak out and do what they are always going to do, healthcare workers should see that for what it is. Mainly something can can be easily solved by keeping people who are or were recently in Africa the fuck out of this country for a few months. |
|
|
|
Posted: 10/4/2014 5:30:55 PM EDT
[#42]
Quote HistoryQuoted: You know very little about human nature. Posted Via AR15.Com Mobile Quote HistoryQuoted: Quoted: Quoted: probably depends a little on how many people are still going to work at the hospital if it gets that bad everybody who is needed will show up. I have zero doubts in that regard You know very little about human nature. Posted Via AR15.Com Mobile everybody who is needed will show up. I have zero doubts in that regard. ETA: Sorry, I misread the question that was being asked... Do I have doubts about the willingness of essential staff to go to work to treat A possible ebola patient, or the possibility of a string of unrelated Ebola patients being admitted? No I do not. A shtf type scenario that was actually being asked about is obviously going to be a different story, yes in a true hollywood style shtf, f that noise finally a chance to get to use some of my gear!!!! but thats just not going to happen. |
|
|
|
Posted: 10/4/2014 6:06:47 PM EDT
[#43]
I think a lot of people underestimate the level of human stupidity. Since I don't work at a hospital I don't know what their abilities are. Something else I've been thinking of though. I think if patients coming to the US aren't properly contained, quick enough, we are going to have issues. Here's why:
1. Every scenario so far people assuming the patients want to be/can be quarantined. Something not thought about is what's going to happen when some moron goes into the hospital with a possible 'sickness' and is informed it may be Ebola/they need to be quarantined. Then they flip out/are in denial and try to leave. 2. Police/first responders are not trained to deal with any kind of scenario involving infectious diseases. 3. When your first responders get infected you are going to pretty much have to declare martial law/get national guard involved. Don't even ask why this is on my mind. Lets just say its an uncomfortable thought. And I'm definitely not a fear mongerer/CT. |
|
|
|
Posted: 10/4/2014 6:14:50 PM EDT
[#44]
Quote HistoryQuoted:
The revenue cycle would work as well as the documentation allowed. At the beginning you would still have sufficient time to gather the required documentation to bill individual insurances. However as the outbreak ramped up documentation would decline and payment for services would suffer. You'd have the majority of the burden initially absorbed by the individual facilities. Then as things cooled down you'd probably see lump reimbursement from the state and federal disaster relief funds. It would definately be a CFO's worst nightmare. Quote HistoryQuoted:
Quoted:
I wonder who would pay for the hospitals' costs? Hospitals, in fact anything medical related, as you know is incredibly expensive. Throw an ebola outbreak into the mix and the costs increase geometrically. The revenue cycle would work as well as the documentation allowed. At the beginning you would still have sufficient time to gather the required documentation to bill individual insurances. However as the outbreak ramped up documentation would decline and payment for services would suffer. You'd have the majority of the burden initially absorbed by the individual facilities. Then as things cooled down you'd probably see lump reimbursement from the state and federal disaster relief funds. It would definately be a CFO's worst nightmare. I can imagine my paperwork volume.. and only because I get all the outside records for scanning for about 800k people...
ETA: I would still go to work, no one would miss me if I caught the ebola |
|
|
|
Posted: 10/4/2014 6:21:53 PM EDT
[#45]
If ebola gets out of control in the USA no hospitals can handle the load. Makeshift clinics is the way to go.
|
|
|
|
Posted: 10/4/2014 6:23:40 PM EDT
[#46]
Quote HistoryQuoted:
[span style='font-weight: bold;']Sorry I have to disagree. In the Northeast most hospitals run at 100% capacity during the flu season. This year hit early. To say hospitals could increase their capacity 50% is simply not reality based. The Er I currently work in runs 100% + capacity most days now. To try and increase that number would require practice changes that practitioners and patients wouldn`t accept. In northern NJ, If you told patients they would have to go in a hallway, or an open ward ( if any still exist), they would have a sh*t fit. And you would have the patient satisfaction clowns compromising patient and staff safety for the sake of their Press-Ganey scores. Quote HistoryQuoted:
Quoted:.
Short answer to the original question. Our healthcare system can handle a LOT. But that means we are in a bad place, and almost any resemblance of what our hospitals look like today would be gone. Generally a hospital is certified to care for a certain number of patients. But every hospital backs off that number when staffing for day to day activities, generally about 50%. And actual utilization of facility services generally hover around 50% of what day to day staffing can handle. So, if we are in a shit hit the fan scenerio and we are calling out all the stops...all physicians are on duty, all nurses, all techs, etc. A hospital can generally handle between 3-400% more capacity than they would on a normal 'busy' day. This would not be a pretty scenerio. Care given would be the primary concern. You wouldn't see full documentation, charts, etc...billing would be suspended, it would be a completely new world. [span style='font-weight: bold;']Sorry I have to disagree. In the Northeast most hospitals run at 100% capacity during the flu season. This year hit early. To say hospitals could increase their capacity 50% is simply not reality based. The Er I currently work in runs 100% + capacity most days now. To try and increase that number would require practice changes that practitioners and patients wouldn`t accept. In northern NJ, If you told patients they would have to go in a hallway, or an open ward ( if any still exist), they would have a sh*t fit. And you would have the patient satisfaction clowns compromising patient and staff safety for the sake of their Press-Ganey scores. Yeah... put me in the "disagree" column too. In fact, I STRONGLY disagree... as in "no fracking way." There is absolutely NO WAY a standard community hospital (which is most of the hospitals in the US) can increase its capacity 3-400%. We regularly (and by that I mean several days per-week, each week) have to board patients in the ER because they don't have enough inpatient beds in the hospital. We also board ICU patients in the ER, sometimes because there aren't enough beds, and sometimes because there aren't enough nurses. Flu and pneumonia season? We board patients seven days a week. We have one negative-pressure isolation room in the ER. If you think you're going to be able to magically increase staffing levels sufficient to care for a bunch of Ebola patients? We hardly have enough staff to care for our normal patients, and how many of those staff members are going to say "f*ck that" when it comes to caring for Ebola victims? You'll have people not show up for work. Straight up. And how about the supplies to care for them? Our hospital did away with Central Sterile Supply several years ago, and has a JIT (Just In Time) distribution/supply system from a large regional warehouse. If they don't have enough stuff there (or transportation is a problem), we're SOL. And where would you put the patients? Hall beds? When they're actively vomiting/defecating blood that's teeming with a trillion death-dealing viruses? We don't have entire wards/floors of empty beds/rooms just sitting around. The occasional old teaching hospital in a major city might have that... but most community hospitals run pretty lean in terms of physical plant. Are you going to set up tents in the parking lot? Sorry, but most community hospitals aren't prepared to deal with any significant number of Ebola patients. |
|
|
|
Posted: 10/4/2014 6:26:13 PM EDT
[#47]
Quote HistoryQuoted:
I think the average is two....And those are usually occupied. Quote HistoryQuoted:
Quoted:
A survey of nurses around the US found that most had no idea what their hospital's plan was, that most believed they had inadaquate amounts of protective gear, and that most hospitals lack or had few overpressure rooms within their facilities. This may get ugly. I think the average is two....And those are usually occupied. And those are not the rooms you want. Positive pressure will push the air out and keeps any germs out of the room. Great if you have a weak patient that you don't want to catch anything from the hallway. For Ebola, you want negative pressure ventilation, that draws the air in and doesn't let anything from the Ebola patient out. I don't work in the medical field, but that same principle applies to other types of contamination too |
|
|
|
Posted: 10/4/2014 6:26:41 PM EDT
[#48]
Dikfer
I would say 6-10 |
|
|
|
Posted: 10/4/2014 6:38:54 PM EDT
[#49]
Ebola patients would most likely be put in isolation units first.
Hospitals around here only have have accommodations for 4 patients at a time. 2 rooms each with 2 per room. Anything over that would be " over extended." As a side note, I watched the drills that the local hospitals stage for emergencies. My main conclusion is that in the event of very serious situation a lot of us are going to die. And remember the doc that was brought over to Atlanta ?? Over 2 million was spent for his care. How many others would just be viewed as " worthless eaters ". And left to die. And how many would die due to the mental shock alone. Stress kills . gd |
|
|
|
Posted: 10/4/2014 6:42:33 PM EDT
[#50]
Quote HistoryQuoted: Ebola patients would most likely be put in isolation units first. Hospitals around here only have have accommodations for 4 patients at a time. 2 rooms each with 2 per room. Anything over that would be " over extended." As a side note, I watched the drills that the local hospitals stage for emergencies. My main conclusion is that in the event of very serious situation a lot of us are going to die. And remember the doc that was brought over to Atlanta ?? Over 2 million was spent for his care. How many others would just be viewed as " worthless eaters ". And left to die. And how many would die due to the mental shock alone. Stress kills . gd I'd venture to say we'll never get to declaring some people to be useless eaters. And that is why we'd be screwed if it ever came to that. |
|
|
Win a FREE Membership!
Sign up for the ARFCOM weekly newsletter and be entered to win a free ARFCOM membership. One new winner* is announced every week!
You will receive an email every Friday morning featuring the latest chatter from the hottest topics, breaking news surrounding legislation, as well as exclusive deals only available to ARFCOM email subscribers.
AR15.COM is the world's largest firearm community and is a gathering place for firearm enthusiasts of all types.
From hunters and military members, to competition shooters and general firearm enthusiasts, we welcome anyone who values and respects the way of the firearm.
Subscribe to our monthly Newsletter to receive firearm news, product discounts from your favorite Industry Partners, and more.
Copyright © 1996-2024 AR15.COM LLC. All Rights Reserved.
Any use of this content without express written consent is prohibited.
AR15.Com reserves the right to overwrite or replace any affiliate, commercial, or monetizable links, posted by users, with our own.
