This issue is all about products—more than 100 are spotlighted here—and some in particular are the subject of concern by manufacturers, health care facilities, and the Centers for Disease Control and Prevention: ventilators. Why is this so? A recent article in The New York Times spells it out.1 Currently there are 105,000 ventilators in the United States. During a regular flu season approximately 100,000 are in use. If, as some experts predict, we see an avian flu pandemic—a virulent human flu that causes a global outbreak of serious illness2—the country would need as many as 742,000. Such a shortage underscores the country’s lack of preparedness for a pandemic. How can this be? Although the Department of Health and Human Services (HHS) has issued a 400-page plan on how to deal with a pandemic, according to a statement by Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, there are not enough ventilators, and there is not much chance they will be available. Congress has authorized $3.8 billion for flu preparedness, and nearly 90% is reserved for vaccines and antiviral drugs. The cost of supplying enough ventilators for a pandemic such as the one in 1918 would cost $18 million.1
Are experts panicking about the flu for no good reason? Not according to Cyndy Miller, RRT, director of clinical education at Newport Medical Instruments, Newport Beach, Calif, who believes the experts have good evidence for predicting that this virulent flu will spread very quickly. “Bird flu predictions have stimulated discussions that are long overdue and may help to bring changes that will help us to be better prepared for a large scale increase in health care needs,” she says.
Hospitals, which run on very tight budgets, are unable to stockpile the requisite number of ventilators, which typically cost $30,000. Are there cheaper alternatives? John L. Hick, MD, professor of emergency medicine at the Mayo Medical School in Minnesota, tells The New York Times, “In a pinch you can hand-bag people.1” Hand-bagging is exhausting and not practical for long-term ventilation of flu victims who might need assistance for an extended time. Also available are CPAP devices. Although cheaper than ventilators at $300 to $6,000, they do not provide the pressure needed to inflate the lungs, nor do they release the pressure to let the lungs empty. Hick, who wrote a paper for the February 2006 Journal of Academic Emergency Medicine outlining a ventilator triage system to be used during emergencies, says that if there is a pandemic, some patients will be taken off ventilators and allowed to die.
What can RTs, most of whom do not determine the budgets for their facilities do about this situation? Some actions to take are to join your state disaster teams or sign up for the HHS Emergency Response Program; get involved with the AARC initiatives, one of which was to advise on the selection of ventilators for the Strategic National Stockpile; or try to participate in the disaster teams in your facilities—only by doing so can you help shape the protocols that determine which patients will be chosen to be on ventilators, and which will die due to their lack in the event of an avian flu pandemic.
1. McNeil DG Jr. Hospitals Short on Ventilators if Bird Flu Hits. Available at: www.nytimes.com/2006/03/12/national/12vent.html Accessed March 17, 2006.
2. Avian Influenza. Available at: www.cdc.gov/flu/avian/gen-info/facts.htm Accessed March 18, 2006.