Tuesday 16th May 2006
Nurses to play frontline role
Nurses will play a vital frontline role in NSW Health plans to deal with an influenza pandemic arising from bird flu.
In the event of a pandemic nurses will staff airport screening stations, temporary staging facilities and fever clinics attached to every emergency department in the State. Nurses will also visit sufferers at home and retired nurses will be asked to return to service.
The avian flu H5N1 virus has so far killed over 90 people in Asia, Turkey and Iraq. Almost all of them caught the disease directly from infected birds.
Experts say a pandemic will become a real danger if the virus mutates to allow efficient human-to-human transmission.
‘It is important to emphasise the difference between the current avian influenza and a pandemic,’ said Dr David Cooper, director of NSW Health’s Counter Disaster Unit.
At the first sign of any pandemic overseas, NSW Health’s newly established Bio-preparedness Unit, assisted by the Counter Disaster Unit, will put the State’s pandemic action plan into effect.
‘In the event of a pandemic reaching Australia, NSW has to be prepared for up to 30,000 hospital admissions and 8000 deaths over a 12-week period,’ said Dr Cooper, an emergency physician.
‘That’s probably a worst-case scenario – I hope it won’t be as bad as that,’ Dr Cooper told The Lamp.
‘We don’t know what the virus would be like, what range of people would be most affected and what sort of complications they might get.’
Dr Cooper’s figures are based on the 1919 Spanish influenza which infected one third of Australians and killed 1.4% of sufferers.
Unusually, that pandemic mainly struck people aged from 20 to 40.
Whatever the casualty rate, Dr Cooper expects the health system would be stretched to the limit.
‘We could lose up to half the health workforce through illness or having to stay home to care for relatives including children, because schools will be closed,’ he said.
‘Nurses will be absolutely vital to the community and we will take every precaution to ensure their safety.’
Dr Cooper said nurses would be issued with personal protective equipment such as masks, gowns, gloves and goggles.
‘Nurses are known for their infection control procedures and skill in the use of personal protective equipment and will lead the way in this regard’ he said.
Authorities will attempt to keep any pandemic from entering Australia during the initial containment phase of the pandemic plan.
Nurses could be stationed at airports to help screen passengers as they arrive and care for people in quarantine.
‘Keeping it out of Australia is probably not possible but it’s worth a try,’ Dr Cooper said. ‘If we can delay its arrival here it might buy us time to develop a vaccine.’
Once the pandemic hits Australia, NSW Health will set up fever clinics attached to every ED in the State.
‘The fever clinic will be part of the ED but not actually in it. It could be in a tent or a hardstand facility but will have to be close to the ED,’ Dr Cooper said.
‘The fever clinic will screen and treat people so they don’t come into the ED and infect the waiting room.
‘It’s a model that came out of the experience fighting SARS in Asia. ED nurses will play a key role in these clinics. The minimum level of staffing in a remote area with no infection would be one nurse, but in areas where outbreaks occur, the minimum would be two nurses, an admin assistant and security people.’
Certain hospitals may be nominated as infectious diseases facilities in an attempt to keep some sites clean.
After being screened at a fever clinic patients will either be sent home, admitted to a designated infectious diseases hospital or placed in a staging facility.
Staging facilities will be set up at sites such as schools or army barracks. They will handle patients who are too ill to go home but not sick enough to be admitted to hospital.
Dr Cooper said community nursing to care for people at home will also play an important role.
‘It’s important this winter that patients with the flu be given a mask on arrival at hospital and everyone has stringent personal hygiene measures like hand-washing. This is good practice at the best of times and vital in the worst,’ he said.