CONTENTS
Introduction
A) The GPs
B) Pharmacies
C) Hospital Structures
D) The population
INTRODUCTION
The wording of the text is intended to generate reflection, to realize the problem and so that solutions can be initiated.
The thread of my thoughts are based on the work that I performed as GP, hospital doctor, and in Africa as head of a hospital and a health zone. Having worked in these diverse areas, Africa and now in the city (Brussels-Schaerbeeck), I have some experience in these two circles of life.
If this humble working on the problem of a pandemic flu raises reactions, then my goal will be reached.
A) GENERAL PRACTITIONERS
1) Doctors will be unable to ensure continuity of care of "current" patients with the influx of flu ill patients.
a) The work overload
In normal times, a full-time general supports an average of medical and administrative work, of around 60-70 hours per week. This places it well beyond most of the hourly average of other professions. It follows that in times of a pandemic, excessive workload to ensure both continuity of care will soon be intolerable, and doctors will be "overbooked" and sadly finally exhausted, disorganized, and sometimes ill. Some will close their offices to escape an unmanageable situation.
b) The safety of doctor and his entourage of work or family
The safety of the doctor and his family could be seriously disturbed by the intrusion and aggression at his home and/or firm by individuals in search of antiviral drugs or any other solution.
c) Care of both (flu sick and not flu sick) impossible.
For obvious reasons of hygiene and contamination, it is clear that it is impossible to merge together in a waiting room these two types of patients, thus increasing the spread of the disease.
2) Solution: specialized mobile team (EMS)
a) Composition:
- A doctor trained in screening patients and the curative and preventive care.
- An ambulance driver
- A 2d ambulance.
- Equipment: Ambulance transport or realistic, protective equipment, communication equipment, materials and antiviral treatments, antibiotics and symptomatic.
Either --------------> modeled on the SAMU
b) The role of doctor
- Treatments: Antivirals medication administered within 36 hours for those presenting with flu and their entourage.
- Sorting patients:
> Those presenting with flu symptoms within 36 hours + his entourage. (See above)
> Those with flu presenting with complications (triage to Specialized Center) + patients entourage (triage to prophylactic treatment).
> Those with flu who are incurable (sent to a CTS for palliative medicine) around her + (triage to prophylactic treatment).
> Flu Patients who have succumbed: Funeral Services specializes prophylactic treatment + the entourage.
- A second possible visit to the home already visited for new problems of infections, and possibly to give guidance to nursing care after visiting the designated or sick.
3) Draft organization to locate the mobile team that specializes
At the top of the organization will be naturally Comissariat inter-ministerial to lead the public health plan and manage the socio-economic stages of the pandemic.
A call-center telephone number unique and easy to remember composed of persons qualified to answer questions about the growing needs of the population in distress (socio-economic) in the channel to adequate services.
The other role of call-center will provide a pilot of a territorial entity (common), appeals and addresses of patients seized, and centralized unit responsible for leading mobile teams specialized in a route optimized.
Rem: The body of fire was a great experience for the management of calls, dispatching and the evacuation of the sick (flu complications ---> See above)
4) Benefits of the intervention of the mobile team specialized health care front line.
a) The continuity of care "current" will be provided normally by the body active generalists.
b) The overbooking and burn-out leading to failure will be avoided.
c) The distibution of antiviral drugs will not be by the general practitioner, health centers and pharmacies, and the safety of those involved in health is maintained.
d) The speed and effectiveness of EMS (specialized mobile teams) will respond effectively and quickly to the request of patients seized while ensuring a sort of patients may be referred to other appropriate structures, a treatment center for specialized treat patients with complications or palliative treatment for patients dying (with the agreement of their families).
Also, the matter of funeral arrangements must be approached with rapport. A responder trained in managing the end of life matters, death of a patient, and necessary and appropriate funeral arrangements. (To enable recycling of pre Funeral Services and provide management of the burial, and ensure burial places are available)
e) The speed and Efficiencies of EMS (specialized mobile teams) will unload the hospital patients spontaneously heading to the emergency services of hospitals.
d) These changes will inhibit public panic, putting their lives further in danger.
B) THE PHARMACY
1) Role of Pharmacy
The role of pharmacies is to deliver the medicines prescribed by a doctor like in the non-pandemic times, and this will clearly be served by all channels of information to the public: either that drugs can be issued by EMS CTS. (Team Specialized Mobile and Specialized Treatment Center) as quickly and effectively receiving a response to medical problems encountered in phase of a pandemic.
So it is pointless to try to go get antiviral drugs in hospitals and pharmacies, or a doctor.
2) But the approach
Ensure the delivery to the pharmacy of medicines prescribed to enable continuity of care in an atmosphere of serenity, or an atmosphere that excludes threats and violence.
C) HOSPITAL
1) The inability of hospitals to jointly ensure the continuity of care "normal" and ill.
a) modeling calculation and quantification of the problem.
"The initial results out of calculation model (Computer program for calculating Professor Van Ranst: see article in the site influenza.be, heading scientific article entitled" Model prepare for a pandemic flu in the date of 28.04.06 ), And analysis of previous pandemics can craidre that the existing health facilities are inadequate during a pandemic. (Phrase taken from the article published by the official website of the Belgian Inter Belgian Comissariat (influenza.be) in an article published in the scientific section in the date 28/04/06, entitled "Second line Pandemic flu ".
b) Seasonal Flu
All doctors with a number of years of practice knows that for some seasonal flu seasons when there is a little higher number of patients, hospitals have been quickly saturated by the number of hospitalized patients, particularly for older persons, and any subject burdened with a chronic illness. As a justifiable precautionary principle we may hospitalize these patients so they can receive a more intensive and more specialized care and avoid unfortunate death.
c) Practicality
In terms of emergency: it would be highly damaging when a portion of ill patients mix with other patients for the obvious reasons of contamination.
Also, this will present a security problem. Remember, only one solution out: the mobile team triages - whether to a hospital or treatment in a "CTS"
At the hospital itself, it is very difficult in terms of contamination and hygiene, to separate the ill from other patients, and negative pressure rooms are very expensive and their numbers rapidly become inadequate. Respirators that function respiratory therapist assisted will keep their first destination, ie for cases requiring conventional resuscitation, and where their numbers are satisfactory.
The movement in the corridors of ill patients would be a disaster, and movement within the hospital should be reduced to their simplest expression, and rigorously controlled by persons protected against contamination and assault.
2) test solution centers for the ill (CSMG)
a) Definition
Any building adaptable and technically meeting the criteria of feasibility of care for patients with complications from illness, and the terminally ill. The building must be clearly separated in space from conventional hospitals so as not to mix the flu ill patients with those with other illness.
Patients seized can arise spontaneously CSMG, but will first have been seen by the mobile team triage physician to determine the presenting illness. Thus the center has no mandate to treat those infected with flu whose treatment can be conducted at home. As a result, these centers will not be saturated by an influx of people not suitable for the type of care that is provided.
b) Role centers
1 Apply a curative treatment for patients with complications seized.
2 Apply a palliative medicine to terminally ill.
c) Construction of buildings and selection of qualified personnel.
The layout of buildings equipment and specialized staff, could be done following the experience of complicated cases already dealt with in different countries around the world who have faced this problem of "avian flu".
The quality of nursing staff will be following internal medicine and palliative medicine.
The inventory and the choice of buildings available, meeting the feasibility criteria should be made early with the help of authorities taking into account the territorial entity (municipalities) to provide early theoretical processing thereof by architects in this field.
Establish a reserve for possible development of buildings or buildings suitable for not being overtaken by the problem, if "worst case" presents itself. (the most serious pandemic).
3) Advantages
a) Allowing hospitals classic function normally to ensure continuity of care and avoid the saturation of a malfunction Illness
b) Avoid mixing problems and consequent contamination of the entrances to hospitals, the emergency department, and the hospital itself.
c) To ensure the safety of care and urgency, and the hospital itself.
d) To recall, the sequence of different phases of the action would be specialized mobile team with yard-treatment, and sometimes then possible to send a specialized center for treatment for sick seized (CSMG).
D) THE PEOPLE
1) Role of the population
Some secular or religious multicultural communities might be tempted to play an important role on the survival of some people more vulnerable by their age and their isolation.
These volunteers could be a source of both information and source of services made to poorest.
This information among secular and religious leaders, could now begin to define the outline of the services provided, after input from their members.
2) Advantages
a) Solidarity has its full expression in terms of efficiency, when people know each other by their close knit neighborhood, their conviction, and their friendships.
The spontaneous solidarity of a people suffering has no barriers, and the history of the past century recounting of the wartime past is full of anecdotes of mutual assistance and generosity.
b) The participation, accountability, and organization of members of a population is that is supportive in adversity results in reduced anxiety, reduced crime, and relief from the misery of a serious disease, which is painful for the entire community.
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