Doctors Prep For Influx Of Swine Flu Cases

An overcrowded emergency room last spring in Mexico City. i i

When swine flu hit last spring many emergency rooms were overcrowded like this one in Mexico City. Health officials are working to inform the public when to go to the emergency room and when to stay home. Joe Raedle/Getty Images hide caption

itoggle caption Joe Raedle/Getty Images
An overcrowded emergency room last spring in Mexico City.

When swine flu hit last spring many emergency rooms were overcrowded like this one in Mexico City. Health officials are working to inform the public when to go to the emergency room and when to stay home.

Joe Raedle/Getty Images

Swine flu is back. Emergency rooms across the country are preparing to accommodate the extra burden on the nation's medical system. To avoid an onslaught of people filling hospitals who would be better off staying home, some doctors are developing questions to help people decide whether they should go to the hospital.

"The flu is hitting in many areas and we're seeing a lot of disease spread as schools and colleges have reopened," said Secretary of Health and Human Services Kathleen Sebelius Friday.

If people who aren't severely ill go to emergency rooms, this not only puts them at risk of getting sicker but also means that potentially severely ill people may not get treated promptly.

When the new H1N1 swine flu first hit last spring, many healthy but worried people flooded emergency rooms. For example, last spring twice as many people as usual came to the emergency room at Mount Sinai Hospital in New York City, says Dr. Lynne Richardson, who runs the ER. The hospital had to keep its clinics open until 11 p.m., she says, and the staff was exhausted.

"We were almost overwhelmed with the number of people who presented to the emergency department seeking care," she says. "Fortunately, most people weren't ill; the vast majority of people who came we were able to discharge home."

What Merits A Hospital Visit?

Richardson and a group of health professionals who met recently in Washington, D.C., realized that many people were there because they didn't know how to figure out if they really had a problem.

"We need to get them information about when you're sick enough to go to an emergency department," Richardson says. Some people need medical help, but many can do just fine at home.

Overflowing emergency rooms can be dangerous places, says Dr. Arthur Kellerman, an emergency room doctor with Emory University.

"It's bad if you've got 300 people at the triage desk, and the 301st person is severely ill," he says. That 301st person may have trouble getting seen. And then there's the issue of sitting in a closed space with people who have been infected by the virus. "If you didn't have H1N1 when you got to the ER, you'll probably have it when you go home."

Kellerman and other health experts met last week in Washington to work on an algorithm — a series of questions that people can answer about their own health, via the Web or telephone. Depending on the answers, people are directed to go to an emergency room, to call their doctor, or to stay home and take care of themselves.

Designing A Decision-Making Tool

The first questions are: Do you have a fever, plus a cough or sore throat? If the answer is no, then you're home free; there's no way you have flu. If it's yes, then the algorithm comes back and asks you about severe symptoms. With difficult breathing, persistent vomiting or other problems, the recommendation is to go to an ER. People with no serious symptoms but diabetes or pregnancy or other health conditions are directed to contact their doctors. With regular flu, and no complications, staying home is best.

Health literacy expert Ruth Parker of Emory University is helping to develop the algorithm. She tested the questions as she dropped her kids off at three colleges last month. She came to a conclusion — don't ask college kids if they have a fever of over 100.4 degrees, because they've thrown out the thermometers their parents so carefully packed.

In testing the questions on others, Parker realized that a lot of people don't know that the new H1N1 and swine flu are one and the same. If she didn't call it swine flu, a lot of people didn't know what she was talking about.

As work continues on the algorithm, the American College of Emergency Physicians has already endorsed the concept, and some government and private organizations are looking into how it can be deployed once it is finalized. And the sooner the better, given that the new flu is taking off, and a lot of people are wondering what to do.

"Right now what we have is a lot of confusion mixed in with fear. We're always more scared of the unknown," says Parker.

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